Provider Demographics
NPI:1821143207
Name:PLEASANT HILL FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:PLEASANT HILL FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-266-1199
Mailing Address - Street 1:5148 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7008
Mailing Address - Country:US
Mailing Address - Phone:515-266-1199
Mailing Address - Fax:515-266-0615
Practice Address - Street 1:5148 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7008
Practice Address - Country:US
Practice Address - Phone:515-266-1199
Practice Address - Fax:515-266-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty