1700867108 NPI number — MARSHALLTOWN ANESTHESIOLOGISTS PLC

Table of content: (NPI 1700867108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700867108 NPI number — MARSHALLTOWN ANESTHESIOLOGISTS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARSHALLTOWN ANESTHESIOLOGISTS PLC
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:
1700867108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2300 MARSHALLTOWN ANESTHESIOLOGISTS PLC
Provider Business Mailing Address City Name:
MARSHALLTOWN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50158-1888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-752-7149
Provider Business Mailing Address Fax Number:
641-752-6320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2300 MARSHALLTOWN ANESTHESIOLOGISTS PLC
Provider Business Practice Location Address City Name:
MARSHALLTOWN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50158-1888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-752-7149
Provider Business Practice Location Address Fax Number:
641-752-6320
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLACK
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
641-752-7149

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1017038 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE9564 . This is a "PGBA PR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41903 . This is a "WELLMARK BCBS OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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