Provider Demographics
NPI:1053499517
Name:MARSHALLTOWN OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:MARSHALLTOWN OBSTETRICS & GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MEYERAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-752-4681
Mailing Address - Street 1:407 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1928
Mailing Address - Country:US
Mailing Address - Phone:641-752-4681
Mailing Address - Fax:641-752-6572
Practice Address - Street 1:407 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1928
Practice Address - Country:US
Practice Address - Phone:641-752-4681
Practice Address - Fax:641-752-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207V00000X
207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09816Medicaid
209816Medicare Oscar/Certification
F43870/H66971Medicare UPIN