Provider Demographics
NPI:1013472174
Name:DEVOTED CANCER CARE LLC
Entity Type:Organization
Organization Name:DEVOTED CANCER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WIEDENHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-559-2767
Mailing Address - Street 1:600 S FIRST ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4174
Mailing Address - Country:US
Mailing Address - Phone:563-559-2767
Mailing Address - Fax:563-559-2768
Practice Address - Street 1:600 S FIRST ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4174
Practice Address - Country:US
Practice Address - Phone:563-559-2767
Practice Address - Fax:563-559-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty