1932199080 NPI number — MELANIE LINN SPENCER PA

Table of content: MELANIE LINN SPENCER PA (NPI 1932199080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932199080 NPI number — MELANIE LINN SPENCER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
MELANIE
Provider Middle Name:
LINN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITEHILL
Provider Other First Name:
MELANIE
Provider Other Middle Name:
LINN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932199080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2605 NORTHRIDGE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50010-4065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-292-4845
Provider Business Mailing Address Fax Number:
515-303-2291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2605 NORTHRIDGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010-4065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-292-4845
Provider Business Practice Location Address Fax Number:
515-303-2291
Provider Enumeration Date:
10/28/2005

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: 363AM0700X , with the licence number:  001669 , 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: 29352 . This is a "WMC-BCBS ER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0424507 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0293522 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0655001 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33444 . This is a "WMC FPC-BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 66046 . This is a "WMC BCBS SNF" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0635011 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0283465 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0600460 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36174 . This is a "WMC-BCBS DME" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 60046 . This is a "WMC BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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