Provider Demographics
NPI:1497984579
Name:PROTEUS INC.
Entity Type:Organization
Organization Name:PROTEUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-348-6646
Mailing Address - Street 1:1221 CENTER ST STE 16
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1014
Mailing Address - Country:US
Mailing Address - Phone:515-271-5306
Mailing Address - Fax:515-271-5309
Practice Address - Street 1:1221 CENTER ST STE 16
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1000
Practice Address - Country:US
Practice Address - Phone:515-271-5303
Practice Address - Fax:515-271-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QF0400X
261QM1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health