MEDICARE: RURAL IOWA SPECIALTY PHYSICIANS CONSORTIUM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1366622946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL IOWA SPECIALTY PHYSICIANS CONSORTIUM INC

Provider Business Mailing Address
First Line	:	5409 NW 88TH ST
Second Line	:	SUITE 200
City	:	JOHNSTON
State	:	IA
Zip	:	50131-2949
Country	:	US
Telephone Number	:	515-362-5980
Fax Number	:	515-362-5985

Provider Business Practice Location Address
First Line	:	4949 PLEASANT STREET
Second Line	:	SUITE 200
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5494
Country	:	US
Telephone Number	:	515-225-7001
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JEAN SHELTON
Credential	:
Telephone Number	:	515-241-4044

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	05/22/2008

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