1649394842 NPI number — IOWA VEIN CENTER, INC.

Table of content: (NPI 1649394842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649394842 NPI number — IOWA VEIN CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA VEIN CENTER, 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:
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:
1649394842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 WESTOWN PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-1425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-222-8346
Provider Business Mailing Address Fax Number:
515-222-0472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 WESTOWN PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-222-8346
Provider Business Practice Location Address Fax Number:
515-222-0472
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVENCIA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
515-222-8346

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CS6841 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 22927 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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