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General NPI Number Information
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NPI Number | 1326090366
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Entity Type | Individual
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Provider Name | BEN G VANCE PA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 5950 UNIVERSITY AVE STE 105
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City | WEST DES MOINES
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State | IA
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Zip | 50266
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Country | US
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Telephone | 515-875-9070
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Fax | 515-875-9071
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Provider Business Mailing Address
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Address Line | 7147 VISTA DR STE 150
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City | WEST DES MOINES
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State | IA
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Zip | 50266-9313
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Country | US
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Telephone | 515-875-9255
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Fax | 515-875-9923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002179
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License Number State | IA
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