Provider Demographics
NPI:1447586102
Name:CENTRAL IOWA PEDIATRIC ALLERGY & PULMONOLOGY, PLLC
Entity Type:Organization
Organization Name:CENTRAL IOWA PEDIATRIC ALLERGY & PULMONOLOGY, PLLC
Other - Org Name:CPAP, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-208-7912
Mailing Address - Street 1:7029 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-9311
Mailing Address - Country:US
Mailing Address - Phone:515-868-0220
Mailing Address - Fax:515-223-3022
Practice Address - Street 1:7029 VISTA DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-9311
Practice Address - Country:US
Practice Address - Phone:515-868-0220
Practice Address - Fax:515-223-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA029342080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1982699260OtherINDIVIDUAL NPI FOR DR SHEETS
IAI10959Medicaid
0297234OtherTITLE 19
0297234OtherTITLE 19