Provider Demographics
NPI:1093932717
Name:BEYOND PINK, LLC
Entity Type:Organization
Organization Name:BEYOND PINK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RNC, CFM
Authorized Official - Phone:712-200-3879
Mailing Address - Street 1:501 ALTA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ALTA
Mailing Address - State:IA
Mailing Address - Zip Code:51002-1437
Mailing Address - Country:US
Mailing Address - Phone:712-200-3879
Mailing Address - Fax:877-475-2403
Practice Address - Street 1:501 ALTA VISTA ST
Practice Address - Street 2:
Practice Address - City:ALTA
Practice Address - State:IA
Practice Address - Zip Code:51002-1437
Practice Address - Country:US
Practice Address - Phone:712-200-3879
Practice Address - Fax:877-475-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5825640001Medicare NSC