Provider Demographics
NPI:1427137520
Name:ANKENY INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:ANKENY INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-289-0096
Mailing Address - Street 1:2201 W 1ST STREET
Mailing Address - Street 2:STE #4
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2484
Mailing Address - Country:US
Mailing Address - Phone:515-289-0096
Mailing Address - Fax:
Practice Address - Street 1:2201 W 1ST STREET
Practice Address - Street 2:STE #4
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2484
Practice Address - Country:US
Practice Address - Phone:515-289-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1221598Medicaid
IAI8886Medicare PIN
IA1221598Medicaid