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95 University Ave Ste 8 Obot Room #100 Des Moines IA 50314-3120 | |
| (515) 244-9500 | |
| (515) 244-9500 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 95 University Ave Ste 8, Des Moines, Iowa |
| Authorized Official Name and Position | Jay Higham (CEO) |
| Authorized Official Contact | 2143656112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5001 Spring Valley Road Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | 95 University Ave Ste 8 Obot Room #100 Des Moines IA 50314-3120 Ph: (515) 244-9500 |
| NPI Number | 1831809862 |
|---|---|
| Provider Enumeration Date | 11/30/2022 |
| Last Update Date | 12/26/2024 |
| Certification Date | 12/26/2024 |
| Medicare PECOS PAC ID | 6608238928 |
|---|---|
| Medicare Enrollment ID | O20230817001579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831809862 | NPI | - | NPPES |
| Provider Name | Paul K Mulhausen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588647887 PECOS PAC ID: 4486796224 Enrollment ID: I20100116000363 |
| Provider Name | Kathleen M Fitzgerald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730190059 PECOS PAC ID: 3476689837 Enrollment ID: I20100325000237 |
| Provider Name | Ashley A Rosas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891272373 PECOS PAC ID: 3375894801 Enrollment ID: I20180924000750 |
| Provider Name | Nnemdi Kamanu Elias |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538369830 PECOS PAC ID: 5395046122 Enrollment ID: I20230818001111 |
| Provider Name | Jacqueline Blackburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326578725 PECOS PAC ID: 0840565172 Enrollment ID: I20240613000304 |
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