1972533917 NPI number — INTERNAL MEDICINE CONSULTANTS, P.C.

Table of content: (NPI 1972533917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972533917 NPI number — INTERNAL MEDICINE CONSULTANTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE CONSULTANTS, P.C.
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:
1972533917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 W TOWNLINE ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CRESTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50801-1054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-782-6440
Provider Business Mailing Address Fax Number:
641-782-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 W TOWNLINE ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CRESTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50801-1054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-782-6440
Provider Business Practice Location Address Fax Number:
641-782-6515
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
641-782-6440

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  02185 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X , with the licence number: 001293 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 02185 . This is a "IOWA LICENSE NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1031757 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001293 . This is a "IOWA LICENSE NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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