Provider Demographics
NPI:1780841544
Name:CENTRAL IOWA PODIATRY INC
Entity Type:Organization
Organization Name:CENTRAL IOWA PODIATRY INC
Other - Org Name:THE FOOT DOCTOR OF MARSHALLTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:641-792-6446
Mailing Address - Street 1:8 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2959
Mailing Address - Country:US
Mailing Address - Phone:641-752-3338
Mailing Address - Fax:
Practice Address - Street 1:8 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2959
Practice Address - Country:US
Practice Address - Phone:641-752-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1780841544OtherUNITED HEALTHCARE
IA1780841544OtherWELLMARK BC/BS
IA1780841544Medicaid
IA3951780002Medicare NSC
IA1780841544OtherWELLMARK BC/BS