Healthcare Provider Details

I. General information

NPI: 1114915220
Provider Name (Legal Business Name): KURT ANTHONY HOUSE D.O.,F.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 1ST ST E
INDEPENDENCE IA
50644-3155
US

IV. Provider business mailing address

1600 1ST ST E
INDEPENDENCE IA
50644-3155
US

V. Phone/Fax

Practice location:
  • Phone: 319-334-2541
  • Fax: 319-334-7054
Mailing address:
  • Phone: 319-334-2541
  • Fax: 319-334-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03021
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: