Provider Demographics
NPI:1821229519
Name:THOMAS K KOITHAN PC
Entity Type:Organization
Organization Name:THOMAS K KOITHAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KIRBY
Authorized Official - Last Name:KOITHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-883-0783
Mailing Address - Street 1:495 S 51ST ST UNIT 40
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-6988
Mailing Address - Country:US
Mailing Address - Phone:515-883-0783
Mailing Address - Fax:
Practice Address - Street 1:495 S 51ST ST UNIT 40
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6988
Practice Address - Country:US
Practice Address - Phone:515-883-0783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA027992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI4144Medicaid
IA1235194143OtherINDIVDUAL NPI
IA0106294Medicaid
IA0106294Medicaid