Provider Demographics
NPI:1366622946
Name:RURAL IOWA SPECIALTY PHYSICIANS CONSORTIUM INC
Entity Type:Organization
Organization Name:RURAL IOWA SPECIALTY PHYSICIANS CONSORTIUM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-241-4044
Mailing Address - Street 1:5409 NW 88TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2949
Mailing Address - Country:US
Mailing Address - Phone:515-362-5980
Mailing Address - Fax:515-362-5985
Practice Address - Street 1:4949 PLEASANT STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5494
Practice Address - Country:US
Practice Address - Phone:515-225-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty