1881656734 NPI number — A STEP AHEAD THERAPY CENTER, INC.

Table of content: (NPI 1881656734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881656734 NPI number — A STEP AHEAD THERAPY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A STEP AHEAD THERAPY CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1881656734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3606 KIMBALL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50702-5731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-234-3736
Provider Business Mailing Address Fax Number:
319-234-0401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3606 KIMBALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50702-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-234-3736
Provider Business Practice Location Address Fax Number:
319-234-0401
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARTLING
Authorized Official First Name:
ALECA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
319-234-3736

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  02547 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 03011 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 35404 . This is a "WELLMARK INDIVIDUAL NUMBE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0415620 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35403 . This is a "WELLMARK INDIVIDUAL NUMBE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0415612 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0415638 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35402 . This is a "WELLMARK OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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