Healthcare Provider Details

I. General information

NPI: 1053499517
Provider Name (Legal Business Name): MARSHALLTOWN OBSTETRICS & GYNECOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E MAIN STREET
MARSHALLTOWN IA
50158-1928
US

IV. Provider business mailing address

407 E MAIN STREET
MARSHALLTOWN IA
50158-1928
US

V. Phone/Fax

Practice location:
  • Phone: 641-752-4681
  • Fax: 641-752-6572
Mailing address:
  • Phone: 641-752-4681
  • Fax: 641-752-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA ANNE MEYERAAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 641-752-4681