Provider Demographics
NPI:1477664951
Name:ORTIZ-BIANCHI, ADA I (MD)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:I
Last Name:ORTIZ-BIANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RIDGE ST
Mailing Address - Street 2:#307
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4643
Mailing Address - Country:US
Mailing Address - Phone:712-329-5700
Mailing Address - Fax:712-329-5759
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:#307
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-329-5700
Practice Address - Fax:712-329-5759
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23300207V00000X
IA36181207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
06286OtherWELLMARK-ATLANTIC
IA2591883Medicaid
IA0591883Medicaid
IA4591883Medicaid
NE10025407200Medicaid
IA0701233OtherSHARE ADV. - RIDGE ST.
NE0701236OtherSHARE ADV - 24TH ST.
IA0701382OtherSHARE ADV - MERCY
07268OtherBCBSN
NE42150546516Medicaid
NE42150546518Medicaid
IA1591883Medicaid
NE42150546520Medicaid
NE0701235OtherSHARE ADV - LAKESIDE
NE42150546517Medicaid
NE0701234OtherSHARE ADV - CENTER
39342OtherWELLMARK-201 RIDGE
IA0701233OtherSHARE ADV. - RIDGE ST.
39342OtherWELLMARK-201 RIDGE
NE279081Medicare ID - Type Unspecified