Provider Demographics
NPI:1326183831
Name:LEE & RUISCH FAMILY MEDICINE PHYSICIANS PC
Entity Type:Organization
Organization Name:LEE & RUISCH FAMILY MEDICINE PHYSICIANS PC
Other - Org Name:LEE & RUISCH FAMILY MEDICINE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-402-2829
Mailing Address - Street 1:5501 NW 86TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1816
Mailing Address - Country:US
Mailing Address - Phone:515-402-2829
Mailing Address - Fax:515-402-2014
Practice Address - Street 1:5501 NW 86TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1816
Practice Address - Country:US
Practice Address - Phone:515-402-2829
Practice Address - Fax:515-402-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE96566Medicare UPIN
IAH74844Medicare UPIN
IAH94011Medicare UPIN