Healthcare Provider Details

I. General information

NPI: 1043979842
Provider Name (Legal Business Name): OPENLOOP HEALTHCARE PARTNERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 6TH AVE STE 400
DES MOINES IA
50309-4108
US

IV. Provider business mailing address

317 6TH AVE STE 400
DES MOINES IA
50309-4108
US

V. Phone/Fax

Practice location:
  • Phone: 515-216-0962
  • Fax:
Mailing address:
  • Phone: 515-216-0962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMIE TERRERO
Title or Position: SR. DIRECTOR OF PROVIDER DATA MNGMT
Credential:
Phone: 201-667-5568