Healthcare Provider Details

I. General information

NPI: 1013472174
Provider Name (Legal Business Name): DEVOTED CANCER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S FIRST ST
CLINTON IA
52732-4174
US

IV. Provider business mailing address

600 S FIRST ST
CLINTON IA
52732-4174
US

V. Phone/Fax

Practice location:
  • Phone: 563-559-2767
  • Fax: 563-559-2768
Mailing address:
  • Phone: 563-559-2767
  • Fax: 563-559-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANYA H WIEDENHOFF
Title or Position: OWNER
Credential:
Phone: 563-559-2767