1609027549 NPI number — COLONIAL MANOR OF ELMA

Table of content: MS. CAROLYN MILES MCNAMARA F.N.P. (NPI 1366792764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609027549 NPI number — COLONIAL MANOR OF ELMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLONIAL MANOR OF ELMA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609027549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 4TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50441-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-456-5636
Provider Business Mailing Address Fax Number:
641-456-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50628-8217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-393-2125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
641-456-5636

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0653865 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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