Provider Demographics
NPI:1881691608
Name:TEW, AMANDA R (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:TEW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 13TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2078
Mailing Address - Country:US
Mailing Address - Phone:515-532-2836
Mailing Address - Fax:515-532-2523
Practice Address - Street 1:215 13TH AVE SW
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2078
Practice Address - Country:US
Practice Address - Phone:515-532-2836
Practice Address - Fax:515-532-2523
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163495OtherFAMILY PRACTICE CLINIC-MEDICARE
IA161302OtherWRIGHT MEDICAL CENTER-MEDICARE
IA0283465OtherFAMILY PRACTICE CLINIC-MEDICAID
IA0600460OtherWRIGHT MEDICAL CENTER-MEDICAID
IA16Z302OtherWRIGHT MEDICAL CENTER-MEDICARE SKILLED
INI12760Medicare ID - Type UnspecifiedIOWA MEDICARE ID#
IA163495OtherFAMILY PRACTICE CLINIC-MEDICARE