=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609000306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTE TCV PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2009
-----------------------------------------------------
Last Update Date | 12/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4949 WESTOWN PKWY STE 100
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-6704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-225-7001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4949 WESTOWN PKWY STE 100
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-6704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-225-7001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. GWEN N CONTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-273-5239
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 34077
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------