Provider Demographics
NPI: | 1780902973 |
---|---|
Name: | KURTZ, QUINN IRA (PA-C) |
Entity type: | Individual |
Prefix: | MR |
First Name: | QUINN |
Middle Name: | IRA |
Last Name: | KURTZ |
Suffix: | |
Gender: | |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2301 STEINDLER WAY STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH LIBERTY |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52317-7907 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 319-338-3606 |
Mailing Address - Fax: | 319-338-0522 |
Practice Address - Street 1: | 2301 STEINDLER WAY STE B |
Practice Address - Street 2: | |
Practice Address - City: | NORTH LIBERTY |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52317-7907 |
Practice Address - Country: | US |
Practice Address - Phone: | 319-338-3606 |
Practice Address - Fax: | 319-338-0522 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-05-12 |
Last Update Date: | 2025-03-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 002121 | 363AS0400X, 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | I75560007 | Other | MEDICARE |