1851378012 NPI number — JOHN A CARSTENSEN MD

Table of content: JOHN A CARSTENSEN MD (NPI 1851378012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851378012 NPI number — JOHN A CARSTENSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARSTENSEN
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851378012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 PLEASANT ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-241-8221
Provider Business Mailing Address Fax Number:
515-241-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-241-8221
Provider Business Practice Location Address Fax Number:
515-241-4001
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  34214 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: ME105681 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1851378012 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00047047 . This is a "RR MEDIACARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0291468 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001716300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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