Provider Demographics
NPI:1275571747
Name:IOWA DIGESTIVE DISEASE CENTER P.C.
Entity Type:Organization
Organization Name:IOWA DIGESTIVE DISEASE CENTER P.C.
Other - Org Name:IOWA DIGESTIVE DISEASE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MERIDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-288-6097
Mailing Address - Street 1:1378 NW 124TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325
Mailing Address - Country:US
Mailing Address - Phone:515-288-6097
Mailing Address - Fax:515-288-8335
Practice Address - Street 1:1378 NW 124TH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:515-288-6097
Practice Address - Fax:515-288-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17117Medicaid
IA17117Medicaid