Basic Information
Provider Information | |||||||||
NPI: | 1184650343 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ACUTE CARE, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1609 N ANKENY BLVD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | ANKENY | ||||||||
State: | IA | ||||||||
PostalCode: | 500234165 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5159642772 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 720 W CENTRAL AVE | ||||||||
Address2: |   | ||||||||
City: | EL DORADO | ||||||||
State: | KS | ||||||||
PostalCode: | 670422112 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3163213300 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/22/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DAVIES | ||||||||
AuthorizedOfficialFirstName: | CHRISTIAN | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CFO | ||||||||
AuthorizedOfficialTelephone: | 5159642772 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
ID | Type | State | Issuer | Description | 111091 | 01 | KS | BC/BS OF KANSAS | OTHER |