Provider Demographics
NPI:1316982200
Name:BOONE COUNTY COMPREHENSIVE SPECIALTY CARE
Entity type:Organization
Organization Name:BOONE COUNTY COMPREHENSIVE SPECIALTY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIENITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-432-3140
Mailing Address - Street 1:1015 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036
Mailing Address - Country:US
Mailing Address - Phone:515-433-8500
Mailing Address - Fax:515-433-8951
Practice Address - Street 1:1015 UNION ST
Practice Address - Street 2:SUITE 120
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4821
Practice Address - Country:US
Practice Address - Phone:515-433-8700
Practice Address - Fax:515-432-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207X00000X, 2086S0105X, 208800000X, 213ES0103X
IA000872213E00000X
IA02837208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty