Provider Demographics
NPI:1720364276
Name:PERINATAL CENTER OF IOWA LLC
Entity Type:Organization
Organization Name:PERINATAL CENTER OF IOWA LLC
Other - Org Name:PERINATAL NURSE PRACTITIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:VELLINGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-247-4278
Mailing Address - Street 1:PO BOX 8204
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50301-8204
Mailing Address - Country:US
Mailing Address - Phone:515-643-6888
Mailing Address - Fax:515-643-6899
Practice Address - Street 1:330 LAUREL ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3068
Practice Address - Country:US
Practice Address - Phone:515-643-6888
Practice Address - Fax:515-643-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1720364276Medicaid