Provider Demographics
NPI:1558533265
Name:NORTHWEST IOWA EAR NOSE AND THROAT, PC
Entity Type:Organization
Organization Name:NORTHWEST IOWA EAR NOSE AND THROAT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-262-8120
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-1194
Mailing Address - Country:US
Mailing Address - Phone:712-262-8120
Mailing Address - Fax:712-262-7028
Practice Address - Street 1:920 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3641
Practice Address - Country:US
Practice Address - Phone:712-262-8120
Practice Address - Fax:712-262-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21909207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2005553Medicaid
IA20242Medicare PIN
IA2005553Medicaid