Healthcare Provider Details

I. General information

NPI: 1477665776
Provider Name (Legal Business Name): FIFTH AVENUE OB GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 UNIVERSITY AVE
DES MOINES IA
50314-3126
US

IV. Provider business mailing address

2213 GRAND AVE
DES MOINES IA
50312-5305
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-4241
  • Fax: 515-243-0209
Mailing address:
  • Phone: 515-237-3974
  • Fax: 515-883-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF060593
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF070928
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01747
License Number StateIA

VIII. Authorized Official

Name: FREDERIC E SAGER
Title or Position: CEO
Credential: D.O.
Phone: 515-243-4241