Healthcare Provider Details

I. General information

NPI: 1083804900
Provider Name (Legal Business Name): NEW FOCUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W WASHINGTON ST
CENTERVILLE IA
52544-1550
US

IV. Provider business mailing address

PO BOX 364
CENTERVILLE IA
52544-0364
US

V. Phone/Fax

Practice location:
  • Phone: 641-437-1722
  • Fax: 641-437-1028
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0736611
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MISSY JOHNSON
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 641-437-1722