Basic Information
| Provider Information | |||||||||
| NPI: | 1114452752 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITYPOINT HEALTH - MARSHALLTOWN | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNITYPOINT HEALTH - FAMILY MEDICINE CLINIC - TAMA/TOLEDO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 UNITYPOINT WAY | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501584749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417545145 | ||||||||
| FaxNumber: | 6418446208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 S BROADWAY ST UPPR LEVEL | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523422307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414845445 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2017 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | DELAGARDELLE | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3192353606 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNITYPOINT HEALTH - MARSHALLTOWN | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.