Provider Demographics
NPI:1124357991
Name:GEORGE T. KAPPOS, MD
Entity Type:Organization
Organization Name:GEORGE T. KAPPOS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAPPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-984-6426
Mailing Address - Street 1:109 2ND STREET
Mailing Address - Street 2:PO BOX 195
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226
Mailing Address - Country:US
Mailing Address - Phone:515-984-6426
Mailing Address - Fax:515-984-6428
Practice Address - Street 1:109 2ND STREET
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226
Practice Address - Country:US
Practice Address - Phone:515-984-6426
Practice Address - Fax:515-984-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21564261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1652Medicare UPIN