Healthcare Provider Details

I. General information

NPI: 1134259427
Provider Name (Legal Business Name): PEDIATRICS AND ADOLESCENT MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 INGERSOLL AVENUE
DES MOINES IA
50312-4015
US

IV. Provider business mailing address

2940 INGERSOLL AVENUE
DES MOINES IA
50312-4015
US

V. Phone/Fax

Practice location:
  • Phone: 515-244-1444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00062
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20027
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number20027
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number20027
License Number StateIA

VIII. Authorized Official

Name: DR. FREDERICK C. ALDRICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 515-244-1444