Healthcare Provider Details

I. General information

NPI: 1265631162
Provider Name (Legal Business Name): CENTRAL IOWA PAIN CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5137 PANORAMA DR
PANORA IA
50216-8614
US

IV. Provider business mailing address

5137 PANORAMA DR
PANORA IA
50216-8614
US

V. Phone/Fax

Practice location:
  • Phone: 641-755-3723
  • Fax: 641-755-3783
Mailing address:
  • Phone: 641-755-3723
  • Fax: 641-755-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIA

VIII. Authorized Official

Name: STEVEN G NAVARRO
Title or Position: PRESIDENT
Credential: CRNA
Phone: 641-755-3783