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NPI Code Detail

MEDICARE: DR. RONALD R. CHILDERSTON D.O.

MEDICARE: DR. RONALD R. CHILDERSTON D.O.
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
1207R00000XInternal Medicine Physician3599IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00310643OTHERIARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518947985
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD R. CHILDERSTON D.O.
Provider Business Mailing Address
First Line : 405 MONROE ST
Second Line :
City : PELLA
State : IA
Zip : 50219-1189
Country : US
Telephone Number : 641-621-2200
Fax Number : 641-621-2335
Provider Business Practice Location Address
First Line : 405 MONROE ST
Second Line :
City : PELLA
State : IA
Zip : 50219-1189
Country : US
Telephone Number : 641-621-2200
Fax Number : 641-621-2335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 08/30/2022

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Directions to “ DR. RONALD R. CHILDERSTON D.O.” Practice Location

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