1891788485 NPI number — JOYCE A VISTA-WAYNE MD

Table of content: JOYCE A VISTA-WAYNE MD (NPI 1891788485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891788485 NPI number — JOYCE A VISTA-WAYNE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISTA-WAYNE
Provider First Name:
JOYCE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1891788485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1475
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:
50305-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-247-4240
Provider Business Mailing Address Fax Number:
515-247-4239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50314-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-247-4240
Provider Business Practice Location Address Fax Number:
515-247-4239
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  32348 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 32348 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: MD-32348 , 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: 42068106058 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 46078 . This is a "WELLMARK, INC BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42068106058 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0168526 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145827 . This is a "IOWA HEALTH SOLUTIONS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: T005 . This is a "TRIWEST" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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