Provider Demographics
NPI:1114108289
Name:CENTRAL IOWA PODIATRY INC
Entity Type:Organization
Organization Name:CENTRAL IOWA PODIATRY INC
Other - Org Name:NEWTON FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:641-792-6446
Mailing Address - Street 1:204 N 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3032
Mailing Address - Country:US
Mailing Address - Phone:641-792-6446
Mailing Address - Fax:641-792-3556
Practice Address - Street 1:204 N 2ND AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3032
Practice Address - Country:US
Practice Address - Phone:641-792-6446
Practice Address - Fax:641-792-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00607213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1114108289OtherWELLMARK BC/BS
IA1114108289Medicaid
IA480025449OtherRR MEDICARE
IA42-1440625-01OtherUNITED HEALTHCARE
IA3951780002Medicare NSC
IAI7868Medicare PIN