Provider Demographics
NPI:1760559017
Name:MEDICALLY YOURS, INC.
Entity Type:Organization
Organization Name:MEDICALLY YOURS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MASTROFSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:515-270-0725
Mailing Address - Street 1:2212 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5230
Mailing Address - Country:US
Mailing Address - Phone:515-270-0725
Mailing Address - Fax:515-270-0166
Practice Address - Street 1:2212 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5230
Practice Address - Country:US
Practice Address - Phone:515-270-0725
Practice Address - Fax:515-270-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081763332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0136721Medicaid
IA1104800001Medicare ID - Type UnspecifiedPROVIDER NUMBER