Provider Demographics
NPI:1912192345
Name:RAMIC DAVENPORT, LLC
Entity Type:Organization
Organization Name:RAMIC DAVENPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPPAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-472-9101
Mailing Address - Street 1:100 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1779
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-573-4629
Practice Address - Street 1:3006 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3012
Practice Address - Country:US
Practice Address - Phone:563-359-5400
Practice Address - Fax:563-359-7400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEG, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAAPPLYING FOR MEDICARMedicare UPIN