Provider Demographics
NPI:1780776864
Name:RONALD R RESCHLY MD, PC
Entity type:Organization
Organization Name:RONALD R RESCHLY MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:RESCHLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-385-6760
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-0349
Mailing Address - Country:US
Mailing Address - Phone:319-385-6760
Mailing Address - Fax:319-385-6764
Practice Address - Street 1:407 S WHITE ST STE 101
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2262
Practice Address - Country:US
Practice Address - Phone:319-385-6760
Practice Address - Fax:319-385-6764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1227397Medicaid
IA24874OtherMEDICAL LICENSE NUMBER
IA24874OtherMEDICAL LICENSE NUMBER
IA=========03OtherRIVER VALLEY ENTITIES
IAI4007Medicare ID - Type Unspecified
IAA02681Medicare UPIN