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General NPI Number Information
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NPI Number | 1083755821
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Entity Type | Organization
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Legal Business Name | PULMONARY INFECTIOUS DISEASE ASSOCIATES PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 EDMUNDSON PL SUITE 312
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4658
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Country | US
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Telephone | 712-396-4295
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Fax | 712-396-4298
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Provider Business Mailing Address
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Address Line | 1 EDMUNDSON PL SUITE 312
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4658
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Country | US
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Telephone | 712-396-4295
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Fax | 712-396-4298
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Authorized Official
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Title or Position | OFC MGR ASSISTANT SEC TREAS
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Name | MRS. LESLIE A SOUTHARD
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Credential |
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Telephone | 712-366-5709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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