1790300648 NPI number — KDP MANAGEMENT SERVICES PLLC

Table of content: (NPI 1790300648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790300648 NPI number — KDP MANAGEMENT SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KDP MANAGEMENT SERVICES PLLC
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:
6
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:
1790300648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 S 50TH ST STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50265-6979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-226-3415
Provider Business Mailing Address Fax Number:
870-252-2681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 S 50TH ST STE 600
Provider Second Line Business Practice Location Address:
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:
50265-6979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-531-6000
Provider Business Practice Location Address Fax Number:
870-252-2681
Provider Enumeration Date:
06/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DOBELIS POHREN
Authorized Official First Name:
KARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
515-218-1399

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 363L00000X . This is a "TAXONOMY" identifier . This identifiers is of the category "OTHER".




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