1629055678 NPI number — DR. SPENCER L CARLSTONE MD

Table of content: DR. SPENCER L CARLSTONE MD (NPI 1629055678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629055678 NPI number — DR. SPENCER L CARLSTONE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSTONE
Provider First Name:
SPENCER
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1629055678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1518 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELLA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50219-7580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-255-2688
Provider Business Mailing Address Fax Number:
641-767-3103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1518 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELLA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50219-7580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-255-2688
Provider Business Practice Location Address Fax Number:
641-767-3103
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  M0031 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: E4698 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 36471 , 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: 3490896 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0490896 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1490896 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2490896 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171434701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4490896 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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