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NPI Code Detail

MEDICARE: TERRY HOWARD MITCHELL MD

MEDICARE: TERRY HOWARD MITCHELL MD
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
1207Q00000XFamily Medicine Physician21985IA

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
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720053796
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY HOWARD MITCHELL MD
Provider Business Mailing Address
First Line : 814 PIERCE ST
Second Line : SUITE 102
City : SIOUX CITY
State : IA
Zip : 51101-1058
Country : US
Telephone Number : 712-226-2600
Fax Number : 712-226-2605
Provider Business Practice Location Address
First Line : 4230 HAMILTON BLVD
Second Line :
City : SIOUX CITY
State : IA
Zip : 51104-1137
Country : US
Telephone Number : 712-239-4300
Fax Number : 712-239-2866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 01/31/2011

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Directions to “ TERRY HOWARD MITCHELL MD” Practice Location

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