Provider Demographics
NPI:1093795411
Name:WEST GRAND MEDICAL ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:WEST GRAND MEDICAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAJOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-226-0112
Mailing Address - Street 1:119 19TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4226
Mailing Address - Country:US
Mailing Address - Phone:515-226-0112
Mailing Address - Fax:515-226-0208
Practice Address - Street 1:119 19TH ST
Practice Address - Street 2:STE 106
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-4226
Practice Address - Country:US
Practice Address - Phone:515-226-0112
Practice Address - Fax:515-226-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25404207Q00000X
IA3475207Q00000X
IA001418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080035337OtherRR MEDICARE
IA0283879Medicaid
IAIA0111OtherJOHN DEERE
IA1236604Medicaid
IAIA0102OtherJOHN DEERE
36457OtherBLUE CROSS
IA1430231Medicaid
IAIA0111OtherJOHN DEERE
H98743Medicare UPIN
IAI12941Medicare ID - Type Unspecified
IA1430231Medicaid