Healthcare Provider Details

I. General information

NPI: 1124282637
Provider Name (Legal Business Name): SPANDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 WILLIAMS PARKWAY SW STE 1
CEDAR RAPIDS IA
52404-1427
US

IV. Provider business mailing address

3235 WILLIAMS PARKWAY SW STE 1
CEDAR RAPIDS IA
52404-1427
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-2311
  • Fax: 319-366-3513
Mailing address:
  • Phone: 319-364-2311
  • Fax: 319-366-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DE ANN M FITZGERALD
Title or Position: MEDICAL DIRECTOR
Credential: O.D.
Phone: 319-366-3500