Basic Information
| Provider Information | |||||||||
| NPI: | 1881691608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEW | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 13TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322836 | ||||||||
| FaxNumber: | 5155322523 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 13TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322836 | ||||||||
| FaxNumber: | 5155322523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 12/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3583 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 163495 | 01 | IA | FAMILY PRACTICE CLINIC-MEDICARE | OTHER | 161302 | 01 | IA | WRIGHT MEDICAL CENTER-MEDICARE | OTHER | 0283465 | 01 | IA | FAMILY PRACTICE CLINIC-MEDICAID | OTHER | 0600460 | 01 | IA | WRIGHT MEDICAL CENTER-MEDICAID | OTHER | 16Z302 | 01 | IA | WRIGHT MEDICAL CENTER-MEDICARE SKILLED | OTHER |