Provider Demographics
NPI:1053320978
Name:CODY'S LIMITED, PC
Entity Type:Organization
Organization Name:CODY'S LIMITED, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:D. THANE
Authorized Official - Middle Name:ROMNEY
Authorized Official - Last Name:CODY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:563-242-5900
Mailing Address - Street 1:425 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4212
Mailing Address - Country:US
Mailing Address - Phone:563-242-5900
Mailing Address - Fax:563-242-5911
Practice Address - Street 1:425 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4212
Practice Address - Country:US
Practice Address - Phone:563-242-5900
Practice Address - Fax:563-242-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31264207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3141838Medicaid
IAI5718Medicare ID - Type Unspecified
IA3141838Medicaid