Provider Demographics
NPI:1497923163
Name:MID IOWA ORTHOPAEDICS, P.C.
Entity Type:Organization
Organization Name:MID IOWA ORTHOPAEDICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-787-9276
Mailing Address - Street 1:300 N 4TH AVE E
Mailing Address - Street 2:SUITE 140B
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3155
Mailing Address - Country:US
Mailing Address - Phone:641-787-9276
Mailing Address - Fax:
Practice Address - Street 1:300 N 4TH AVE E
Practice Address - Street 2:SUITE 140B
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3155
Practice Address - Country:US
Practice Address - Phone:641-787-9276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27934261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0002105Medicaid
IA0002105Medicaid