Basic Information
| Provider Information | |||||||||
| NPI: | 1275872152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IOWA PAIN MANAGEMENT, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503125305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152373974 | ||||||||
| FaxNumber: | 5158832692 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W HUTCHINGS ST | ||||||||
| Address2: | |||||||||
| City: | WINTERSET | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502732109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153138649 | ||||||||
| FaxNumber: | 5153138649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2013 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | BIGGERSTAFF | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5153138649 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 3994 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | DV3214 | 01 | IA | RR MEDICARE | OTHER | 1275872152 | 05 | IA | MEDICAID |