MEDICARE: GREGORY SCOTT VANPEURSEM PA-C

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	363A00000X	Physician Assistant	001397	IA

General Provider Information

NPI Number	:	1548253438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SCOTT VANPEURSEM PA-C

Provider Business Mailing Address
First Line	:	2121 HEGG DR
Second Line	:
City	:	ROCK VALLEY
State	:	IA
Zip	:	51247-1445
Country	:	US
Telephone Number	:	712-476-8100
Fax Number	:	712-476-8190

Provider Business Practice Location Address
First Line	:	2121 HEGG DR
Second Line	:
City	:	ROCK VALLEY
State	:	IA
Zip	:	51247-1445
Country	:	US
Telephone Number	:	712-476-8100
Fax Number	:	712-476-8190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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