Healthcare Provider Details

I. General information

NPI: 1306661780
Provider Name (Legal Business Name): CENTRAL IOWA PAIN & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 UNIVERSITY BLVD STE 102
AMES IA
50010-8674
US

IV. Provider business mailing address

2405 N DAKOTA AVE
AMES IA
50014-9019
US

V. Phone/Fax

Practice location:
  • Phone: 515-493-7002
  • Fax:
Mailing address:
  • Phone: 785-608-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACOB MILLER
Title or Position: CEO/MANAGER
Credential: CRNA, ARNP
Phone: 785-608-7659