Basic Information
| Provider Information | |||||||||
| NPI: | 1346661659 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BUSINESS REVENUE CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPECTRUM HEALTH CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71602 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503250602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152432057 | ||||||||
| FaxNumber: | 5152445570 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 N 2ND AVE W | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502083015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152432057 | ||||||||
| FaxNumber: | 5152445570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2014 | ||||||||
| LastUpdateDate: | 01/04/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LOYNACHAN | ||||||||
| AuthorizedOfficialFirstName: | CLOVER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BILLING/CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5152435027 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.