Provider Demographics
NPI:1043299449
Name:VIRCKS, BRUCE E (AUD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:VIRCKS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6200
Mailing Address - Fax:641-752-7420
Practice Address - Street 1:309 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2946
Practice Address - Country:US
Practice Address - Phone:641-754-6200
Practice Address - Fax:641-752-7420
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00190237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0423756Medicaid
IA06170Medicare ID - Type Unspecified
IA0423756Medicaid