MEDICARE: DIAGNOSTIC & CRITICAL CARE MEDICINE

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	207R00000X	Internal Medicine Physician	0000	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

General Provider Information

NPI Number	:	1932104593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC & CRITICAL CARE MEDICINE

Provider Business Mailing Address
First Line	:	411 LAUREL ST
Second Line	:	STE 3275
City	:	DES MOINES
State	:	IA
Zip	:	50314-3027
Country	:	US
Telephone Number	:	515-247-4113
Fax Number	:	515-643-8779

Provider Business Practice Location Address
First Line	:	1510 PLEASANT VIEW DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50315-2126
Country	:	US
Telephone Number	:	515-771-2527
Fax Number	:	855-642-1942

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MITCH HARRIS
Credential	:
Telephone Number	:	515-865-4567

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	12/13/2022

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Directions to “DIAGNOSTIC & CRITICAL CARE MEDICINE ” Practice Location

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