Healthcare Provider Details

I. General information

NPI: 1811043326
Provider Name (Legal Business Name): MIDWEST AMBUCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 KEOSAUQUA WAY
DES MOINES IA
50309-1007
US

IV. Provider business mailing address

2535 106TH ST
URBANDALE IA
50322-3766
US

V. Phone/Fax

Practice location:
  • Phone: 515-244-0409
  • Fax: 515-243-4932
Mailing address:
  • Phone: 515-252-1721
  • Fax: 515-252-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number06-38844
License Number StateIA

VIII. Authorized Official

Name: MR. KIM EUGENE CHAPMAN
Title or Position: PRESIDENT
Credential:
Phone: 515-252-1721