Provider Demographics
NPI:1790775138
Name:PET CO., LLC
Entity Type:Organization
Organization Name:PET CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:515-875-9101
Mailing Address - Street 1:7147 VISTA DR STE 160
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-9313
Mailing Address - Country:US
Mailing Address - Phone:515-875-9924
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:STE 150A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-244-5109
Practice Address - Fax:515-241-3505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE IOWA CLINIC HOLDING COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4532800001Medicare NSC