Provider Demographics
NPI:1750474318
Name:MYRIE & ASSOCIATES
Entity type:Organization
Organization Name:MYRIE & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENVILLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-490-8950
Mailing Address - Street 1:PO BOX 8057
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50301-8057
Mailing Address - Country:US
Mailing Address - Phone:515-225-3355
Mailing Address - Fax:515-222-1828
Practice Address - Street 1:974 73RD ST
Practice Address - Street 2:SUITE 25
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1024
Practice Address - Country:US
Practice Address - Phone:515-225-3355
Practice Address - Fax:515-222-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2261560Medicaid
IA39903OtherWELLMARK BLUE CROSS BLUE SHIELD
IAG55648Medicare UPIN
IA39903OtherWELLMARK BLUE CROSS BLUE SHIELD
IAI16379Medicare PIN