Provider Demographics
NPI:1346406816
Name:MDCC, PC
Entity Type:Organization
Organization Name:MDCC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:I
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-278-0456
Mailing Address - Street 1:5525 MEREDITH DR
Mailing Address - Street 2:STE B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2334
Mailing Address - Country:US
Mailing Address - Phone:515-278-9456
Mailing Address - Fax:515-251-4021
Practice Address - Street 1:5525 MEREDITH DR
Practice Address - Street 2:STE B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2334
Practice Address - Country:US
Practice Address - Phone:515-278-9456
Practice Address - Fax:515-251-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06179261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center