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NPI Code Detail

MEDICARE: MR. STEVEN WILLIAM BLUM PA C FNP C

MEDICARE: MR. STEVEN WILLIAM BLUM PA C FNP C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant000828IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970008132OTHERRR MEDICARE

General Provider Information

NPI Number : 1629060801
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEVEN WILLIAM BLUM PA C FNP C
Provider Business Mailing Address
First Line : 1501 S MAIN ST STE 6
Second Line :
City : CHARLES CITY
State : IA
Zip : 50616-3444
Country : US
Telephone Number : 641-228-5151
Fax Number : 641-228-2902
Provider Business Practice Location Address
First Line : 1501 S MAIN ST STE 6
Second Line :
City : CHARLES CITY
State : IA
Zip : 50616-3444
Country : US
Telephone Number : 641-228-5151
Fax Number : 641-228-2902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 11/20/2017

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