Healthcare Provider Details

I. General information

NPI: 1497366231
Provider Name (Legal Business Name): OBRIA MEDICAL CLINIC OF AMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 GOLDEN ASPEN DR STE 105
AMES IA
50010-8011
US

IV. Provider business mailing address

1606 GOLDEN ASPEN DR STE 105
AMES IA
50010-8011
US

V. Phone/Fax

Practice location:
  • Phone: 515-298-2073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA J ADAMS
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 319-850-2123