Provider Demographics
NPI:1093945784
Name:RESPIRATORY & CRITICAL CARE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:RESPIRATORY & CRITICAL CARE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-286-4364
Mailing Address - Street 1:PO BOX 8305
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50301-8305
Mailing Address - Country:US
Mailing Address - Phone:319-286-4364
Mailing Address - Fax:319-558-4996
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:SUITE 5000
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5036
Practice Address - Country:US
Practice Address - Phone:319-286-4364
Practice Address - Fax:319-558-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31181207RC0200X, 207RP1001X
IA104824207RC0200X, 207RP1001X
IA78725207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00750729OtherRR MEDICARE