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General NPI Number Information
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NPI Number | 1902865082
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN IOWA MEDICAL SERVICES
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 1223 S GEAR AVE STE 202
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1685
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Country | US
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Telephone | 319-768-4350
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Fax | 319-768-4355
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Provider Business Mailing Address
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Address Line | PO BOX 540
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-0540
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Country | US
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Telephone | 319-768-4350
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Fax | 319-768-4355
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Authorized Official
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Title or Position | EXEC DIRECTOR
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Name | LYNETTE COLLIER
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Credential |
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Telephone | 319-768-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 21014
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License Number State | IA
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