Healthcare Provider Details

I. General information

NPI: 1790868057
Provider Name (Legal Business Name): DR ROBERT EELLS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E ARMY POST RD SUITE 470
DES MOINES IA
50315-5970
US

IV. Provider business mailing address

1111 E ARMY POST RD SUITE 470
DES MOINES IA
50315-5970
US

V. Phone/Fax

Practice location:
  • Phone: 515-244-0633
  • Fax: 515-244-2412
Mailing address:
  • Phone: 515-244-0633
  • Fax: 515-244-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number00571
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00571
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number00571
License Number StateIA

VIII. Authorized Official

Name: DR. ROBERT EELLS
Title or Position: OWNER
Credential: DPM
Phone: 515-244-0633