Provider Demographics
NPI:1013943497
Name:CRITICAL CARE MEDICINE PC
Entity Type:Organization
Organization Name:CRITICAL CARE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLOWER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:515-720-7755
Mailing Address - Street 1:708 FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2520
Mailing Address - Country:US
Mailing Address - Phone:515-875-4000
Mailing Address - Fax:515-875-4005
Practice Address - Street 1:95 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3120
Practice Address - Country:US
Practice Address - Phone:515-875-4000
Practice Address - Fax:515-875-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33889207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F58061Medicare UPIN