Provider Demographics
NPI:1609932201
Name:PEDIATRIC & ADULT ALLERGY PC
Entity type:Organization
Organization Name:PEDIATRIC & ADULT ALLERGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-244-7229
Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1410
Mailing Address - Country:US
Mailing Address - Phone:515-244-7229
Mailing Address - Fax:
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1410
Practice Address - Country:US
Practice Address - Phone:515-244-7229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0166314Medicaid
IA08218Medicare PIN