Provider Demographics
NPI:1003868639
Name:BLUFFS OBGYN AND INCONTINENCE CTR
Entity type:Organization
Organization Name:BLUFFS OBGYN AND INCONTINENCE CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:712-256-8080
Mailing Address - Street 1:300 W BROADWAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9066
Mailing Address - Country:US
Mailing Address - Phone:712-256-8080
Mailing Address - Fax:712-256-8082
Practice Address - Street 1:300 W BROADWAY
Practice Address - Street 2:SUITE 111
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9066
Practice Address - Country:US
Practice Address - Phone:712-256-8080
Practice Address - Fax:712-256-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1003868639Medicaid