Provider Demographics
NPI:1699935981
Name:PODIATRISTS PC
Entity type:Organization
Organization Name:PODIATRISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-364-0297
Mailing Address - Street 1:1300 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4008
Mailing Address - Country:US
Mailing Address - Phone:319-364-0297
Mailing Address - Fax:319-364-0298
Practice Address - Street 1:1300 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4008
Practice Address - Country:US
Practice Address - Phone:319-364-0297
Practice Address - Fax:319-364-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000320261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0002725Medicaid
IA00272OtherBLUE CROSS BLUE SHIELD
IA00272OtherBLUE CROSS BLUE SHIELD