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General NPI Number Information
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NPI Number | 1316982200
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Entity Type | Organization
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Legal Business Name | BOONE COUNTY COMPREHENSIVE SPECIALTY CARE
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 1015 UNION ST SUITE 120
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City | BOONE
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State | IA
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Zip | 50036-4821
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Country | US
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Telephone | 515-433-8700
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Fax | 515-432-6962
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Provider Business Mailing Address
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Address Line | 1015 UNION ST
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City | BOONE
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State | IA
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Zip | 50036
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Country | US
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Telephone | 515-433-8500
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Fax | 515-433-8951
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Authorized Official
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Title or Position | CEO
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Name | MIKAELA KIENITZ
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Credential |
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Telephone | 515-432-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000872
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License Number State | IA
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Taxonomy #6
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 02837
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License Number State | IA
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