Provider Demographics
NPI:1740443712
Name:THOMAS E JESSEN MD PC
Entity type:Organization
Organization Name:THOMAS E JESSEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:JESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-792-2380
Mailing Address - Street 1:300 N 4TH AVE E STE 140A
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3122
Mailing Address - Country:US
Mailing Address - Phone:641-792-2380
Mailing Address - Fax:641-792-6184
Practice Address - Street 1:300 N 4TH AVE E STE 140A
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3122
Practice Address - Country:US
Practice Address - Phone:641-792-2380
Practice Address - Fax:641-792-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17964174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0063651Medicaid
IAA00818Medicare UPIN
IA06365Medicare PIN