1811942659 NPI number — W C KOENIG JR MD PC

Table of content: (NPI 1811942659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811942659 NPI number — W C KOENIG JR MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W C KOENIG JR MD PC
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:
1811942659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2213 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50312-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-237-3974
Provider Business Mailing Address Fax Number:
515-883-2692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50312-5375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-283-1570
Provider Business Practice Location Address Fax Number:
515-283-1681
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOENIG
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
515-237-3974

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , 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: 0301861 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DH0057 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com