Healthcare Provider Details

I. General information

NPI: 1154375731
Provider Name (Legal Business Name): JAMESON ORTHOPEDIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE SUITE 159
WEST BURLINGTON IA
52655-1691
US

IV. Provider business mailing address

2213 GRAND AVE
DES MOINES IA
50312-5305
US

V. Phone/Fax

Practice location:
  • Phone: 319-752-4553
  • Fax: 319-753-0462
Mailing address:
  • Phone: 515-237-3974
  • Fax: 515-883-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIA

VIII. Authorized Official

Name: THERON QUENTIN JAMESON
Title or Position: PRESIDENT AND CEO
Credential: D.O.
Phone: 319-752-4553