MEDICARE: MYRIE & ASSOCIATES

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	34603	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	39903	OTHER	IA	WELLMARK BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1750474318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRIE & ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 8057
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50301-8057
Country	:	US
Telephone Number	:	515-225-3355
Fax Number	:	515-222-1828

Provider Business Practice Location Address
First Line	:	974 73RD ST
Second Line	:	SUITE 25
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1024
Country	:	US
Telephone Number	:	515-225-3355
Fax Number	:	515-222-1828

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DENVILLE A MYRIE
Credential	:	MD
Telephone Number	:	515-490-8950

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/04/2010

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Directions to “MYRIE & ASSOCIATES ” Practice Location

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