Provider Demographics
NPI: | 1437628468 |
---|---|
Name: | IOWA TOTAL CARE, INC |
Entity Type: | Organization |
Organization Name: | IOWA TOTAL CARE, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VICE PRESIDENT, MEDICAID SOLUTIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHRISTOPHER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PRIEST |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 314-302-2859 |
Mailing Address - Street 1: | 7700 FORSYTH BLVD STE 800 |
Mailing Address - Street 2: | |
Mailing Address - City: | CLAYTON |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63105-1849 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1080 JORDAN CREEK PARKWAY |
Practice Address - Street 2: | |
Practice Address - City: | WEST DES MONIES |
Practice Address - State: | IA |
Practice Address - Zip Code: | 58026 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-725-4477 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-11-20 |
Last Update Date: | 2018-11-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302R00000X | Managed Care Organizations | Health Maintenance Organization |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 302R0000X | Other | TAXONOMY CODE |