Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Podiatrist |
|---|
| Location | 813 Church St., Shenandoah, Iowa |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1912119124
- Provider Enumeration Date: 05/03/2007
- Last Update Date: 09/15/2015
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912119124 | NPI | - | NPPES |
| 0429761 | Medicaid | IA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 213E00000X | Podiatrist | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
502 E Reed St.,
Red Oak, IA 51566
Ph: (712) 623-5178 |
813 Church St.,
Shenandoah, IA 51601
Ph: (712) 246-5866 |
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