1629299672 NPI number — PENTACREST, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629299672 NPI number — PENTACREST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENTACREST, INC.
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:
PATHWAYS
Provider Other Organization Name Type Code:
5
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:
1629299672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 1ST ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52405-2713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-398-3644
Provider Business Mailing Address Fax Number:
319-398-3937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
817 PEPPERWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-7005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-339-6162
Provider Business Practice Location Address Fax Number:
319-339-6164
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BATCHELER
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER BILLING
Authorized Official Telephone Number:
319-743-9529

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0746644 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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