Provider Demographics
NPI:1518214204
Name:LONG TERM CARE SERVICES PC
Entity Type:Organization
Organization Name:LONG TERM CARE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:515-327-2089
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:5927 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2825
Practice Address - Country:US
Practice Address - Phone:515-327-2089
Practice Address - Fax:515-440-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02075207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIN PROCESSMedicaid
IAIN PROCESSMedicaid