Healthcare Provider Details

I. General information

NPI: 1093945784
Provider Name (Legal Business Name): RESPIRATORY & CRITICAL CARE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE SUITE 5000
CEDAR RAPIDS IA
52402-5036
US

IV. Provider business mailing address

PO BOX 8305
DES MOINES IA
50301-8305
US

V. Phone/Fax

Practice location:
  • Phone: 319-286-4364
  • Fax: 319-558-4996
Mailing address:
  • Phone: 319-286-4364
  • Fax: 319-558-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number31181
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number104824
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number78725
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number104824
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number78725
License Number StateIA
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number31181
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00750729
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerRR MEDICARE

VIII. Authorized Official

Name: MRS. KELLY JO MAHONEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 319-286-4364