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5260 Northwest Blvd Suite 2 Davenport IA 52806-2463 | |
(563) 445-2400 | |
(563) 445-2404 |
Full Name | |
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Speciality | Clinic/center |
Location | 5260 Northwest Blvd, Davenport, Iowa |
Authorized Official Name and Position | Rob F Hentzen (CEO) |
Authorized Official Contact | 5153313190 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4725 Merle Hay Rd Suite 107 Des Moines IA 50322-1983 Ph: (515) 331-3190 | 5260 Northwest Blvd Suite 2 Davenport IA 52806-2463 Ph: (563) 445-2400 |
NPI Number | 1033349253 |
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Provider Enumeration Date | 07/22/2009 |
Last Update Date | 08/19/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033349253 | NPI | - | NPPES |
0665802 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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