Healthcare Provider Details

I. General information

NPI: 1861525396
Provider Name (Legal Business Name): AUNT MINNIE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 GRAND AVE
DES MOINES IA
50312-5304
US

IV. Provider business mailing address

2213 GRAND AVE
DES MOINES IA
50312-5305
US

V. Phone/Fax

Practice location:
  • Phone: 515-288-0206
  • Fax: 714-475-0417
Mailing address:
  • Phone: 515-237-3974
  • Fax: 515-883-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number3529
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number3529
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number3529
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3529
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number3529
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number3529
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number3529
License Number StateIA
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number3529
License Number StateIA
# 9
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number3529
License Number StateIA

VIII. Authorized Official

Name: DR. ROBERT VINCENT FILIPPONE JR.
Title or Position: RADIOLOGIST
Credential: DO
Phone: 515-288-0206