Provider Demographics
NPI:1235228826
Name:HEAVY MEDICINE INCORPORATED P C
Entity Type:Organization
Organization Name:HEAVY MEDICINE INCORPORATED P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-262-8707
Mailing Address - Street 1:1300 DES MOINES STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5547
Mailing Address - Country:US
Mailing Address - Phone:515-262-8707
Mailing Address - Fax:515-265-5207
Practice Address - Street 1:1300 DES MOINES ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5502
Practice Address - Country:US
Practice Address - Phone:515-262-8707
Practice Address - Fax:515-265-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19808OtherWELLMARK
IA0198085Medicaid
IA19808Medicare ID - Type Unspecified