Provider Demographics
NPI:1285689182
Name:COMPANY MEDICINE PC
Entity Type:Organization
Organization Name:COMPANY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:N
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PREVO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-222-4419
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:5901 WESTOWN PKWY
Practice Address - Street 2:SUITE 225
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8218
Practice Address - Country:US
Practice Address - Phone:515-222-4419
Practice Address - Fax:515-222-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE67862Medicare UPIN