Healthcare Provider Details

I. General information

NPI: 1104639962
Provider Name (Legal Business Name): HRT IA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S 50TH ST STE 101
WEST DES MOINES IA
50265-5382
US

IV. Provider business mailing address

800 S 50TH ST STE 101
WEST DES MOINES IA
50265-5382
US

V. Phone/Fax

Practice location:
  • Phone: 725-204-6055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 602-796-2559