Healthcare Provider Details

I. General information

NPI: 1497984579
Provider Name (Legal Business Name): PROTEUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 CENTER ST STE 16
DES MOINES IA
50309-1000
US

IV. Provider business mailing address

1221 CENTER ST STE 16
DES MOINES IA
50309-1014
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-5303
  • Fax: 515-271-5309
Mailing address:
  • Phone: 515-271-5306
  • Fax: 515-271-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESUS SOTO
Title or Position: CEO
Credential:
Phone: 515-348-6646