Provider Demographics
NPI:1003073206
Name:CENTRAL IOWA PODIATRY INC
Entity Type:Organization
Organization Name:CENTRAL IOWA PODIATRY INC
Other - Org Name:PELLA FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-752-3338
Mailing Address - Street 1:908 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1504
Mailing Address - Country:US
Mailing Address - Phone:641-628-3542
Mailing Address - Fax:641-628-8638
Practice Address - Street 1:405 MONROE ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1189
Practice Address - Country:US
Practice Address - Phone:641-628-3542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00607213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1003073206Medicaid
IA1003073206OtherWELLMARK BC/BS
IA421440625-04OtherUNITED HEALTHCARE
IA1003073206OtherUNITED HEALTHCARE
IA480026192OtherRR MEDICARE
IA480026192OtherRR MEDICARE
IA421440625-04OtherUNITED HEALTHCARE