Provider Demographics
NPI:1134670532
Name:BRIAN VOLD ARNP PLC
Entity Type:Organization
Organization Name:BRIAN VOLD ARNP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VOLD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:641-420-0217
Mailing Address - Street 1:1239 CERRO GORDO ST
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50475-8123
Mailing Address - Country:US
Mailing Address - Phone:641-420-0217
Mailing Address - Fax:
Practice Address - Street 1:814 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-2113
Practice Address - Country:US
Practice Address - Phone:641-648-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG127881261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)