Basic Information
| Provider Information | |||||||||
| NPI: | 1043279706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EIBES | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 1ST ST SE | ||||||||
| Address2: | |||||||||
| City: | BELMOND | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504211201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153272000 | ||||||||
| FaxNumber: | 5153272019 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 1ST ST SE | ||||||||
| Address2: | |||||||||
| City: | BELMOND | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504211201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153272000 | ||||||||
| FaxNumber: | 5153272019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31108 | IA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1043279706 | 05 | IA | MEDICAID | 1192047 | 05 | IA | MEDICAID |