Healthcare Provider Details

I. General information

NPI: 1093165565
Provider Name (Legal Business Name): IOWA PEDIATRIC ASTHMA & ALLERGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7029 VISTA DR
WEST DES MOINES IA
50266-9311
US

IV. Provider business mailing address

7029 VISTA DR
WEST DES MOINES IA
50266-9311
US

V. Phone/Fax

Practice location:
  • Phone: 515-868-0220
  • Fax: 515-223-3022
Mailing address:
  • Phone: 515-868-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number02934
License Number StateIA

VIII. Authorized Official

Name: DR. SCOTT JAMES SHEETS
Title or Position: PRESIDENT
Credential: DO
Phone: 515-868-0220