Provider Demographics
NPI:1831491182
Name:JANA POOCK DPM PC
Entity Type:Organization
Organization Name:JANA POOCK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:POOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-953-9816
Mailing Address - Street 1:1340 E HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8137
Mailing Address - Country:US
Mailing Address - Phone:515-987-8833
Mailing Address - Fax:515-987-3718
Practice Address - Street 1:1340 E HICKMAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8137
Practice Address - Country:US
Practice Address - Phone:515-987-8833
Practice Address - Fax:515-987-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00765261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric