PREVENTATIVE HEALTH CLINIC INC (NPI# 1922279439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922279439 |
| Entity Type | Organization |
| Organization Name | PREVENTATIVE HEALTH CLINIC INC |
| Practice Address |
2480 Berkshire Pkwy Clive IA 50325-4678 |
| Mailing Address |
2213 Grand Ave Des Moines IA 50312-5305 |
| Practice Telephone | 5152252578 |
| Practice Fax Number | 5152252598 |
| Mailing Telephone | 5152373974 |
| Mailing Fax Number | 5158832692 |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-12-02 |
| Authorized Official Name | ANGELIA RENEE WHETRO (MED DIRECTOR) |
| Authorized Official Telephone | 5152252578 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 001132 | IA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 111N00000X | Chiropractor | 007026 | IA | Chiropractic Providers |
| Y | 207Q00000X | Family Medicine | 03475 | IA | Allopathic & Osteopathic Physicians |
| Street Address |
2480 BERKSHIRE PKWY |
| City | CLIVE |
| State | IA |
| Zip Code | 50325-4678 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992793723 | Susan L. Cross | Nurse Practitioner | 2480 Berkshire Pkwy, Clive, IA 50325-4683 | 2005-10-06 |
| 1649560236 | Urban Effects Medspa Inc. | Nurse Practitioner | 2480 Berkshire Pkwy, Suite B, Clive, IA 50325-4683 | 2011-04-15 |
| 1033190467 | Michon Dianne Leddy | Physician Assistant | 2480 Berkshire Pkwy, Clive, IA 50325-4678 | 2005-11-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104449446 | Clive Behavioral Health LLC | Psychiatric Hospital | 1500 Nw 114th St, Clive, IA 50325 | 2020-05-21 |
| 1609426519 | Caroline Silva Pereira Lara Ribeiro | Occupational Therapist | 15500 Boston Parkway, Appt 110, Clive, IA 50325 | 2019-09-13 |
| 1487203873 | Karen Turnure | Technician | 4524 Nw 16th St, Clive, IA 50325 | 2019-09-09 |
| 1659920320 | Phs Walnut Ridge LLC | Skilled Nursing Facility | 1703 Campus Drive, Clive, IA 50325 | 2019-09-05 |
| 1700288834 | Lindsey White | Chiropractor | 12931 University Ave, Suite 103, Clive, IA 50325 | 2014-09-19 |
| 1811337389 | Metro West Learning Center, LLC | Counselor | 13300 Hickman Rd Ste 110, Clive, IA 50325 | 2013-06-28 |
| 1700110343 | Rodolfo Mallorca Legislador Sr. | Family Medicine | 1665 Nw 97th St., Clive, IA 50325 | 2009-09-30 |
| 1891961900 | Erin Ducharme | Dermatology | 16349 Sheridan Drive, Suite 101, Clive, IA 50325 | 2008-05-08 |
| 1174792873 | The Iowa Clinic PC | Prosthetic/Orthotic Supplier | 12655 University Ave, Ste 160, Clive, IA 50325 | 2008-02-27 |
| 1164623393 | Melisa Coaker | Internal Medicine | 1275 Nw 128th St, Ste 200, Clive, IA 50325 | 2007-05-28 |
| Find all providers in zip 50325 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447656046 | Steven J. Humphrey | Family Medicine | 14961 Woodcreek Ln, Clive, IA 50325-4511 | 2014-11-08 |
| 1700110343 | Rodolfo Mallorca Legislador Sr. | Family Medicine | 1665 Nw 97th St., Clive, IA 50325 | 2009-09-30 |
| 1396759163 | Imad F Francis | Family Medicine | 1601 Nw 114th St Ste 257, Clive, IA 50325-7013 | 2006-07-28 |
| 1063437812 | Daniel Charles Miller | Family Medicine | 12871 University Ave, Suite 130, Clive, IA 50325-8255 | 2006-07-13 |
| 1326095399 | Lon Russell Brewer | Family Medicine | 1924 Nw 88th Ct, Clive, IA 50325-5463 | 2006-05-27 |
| 1730178914 | Charles Francis Keller | Family Medicine | 1601 Nw 114th Street, Suite 257, Clive, IA 50325-7036 | 2005-10-19 |
| 1801096979 | Prachi Singh | Family Medicine | 1601 Nw 114th St, Suite 247, Clive, IA 50325-7007 | 2007-07-18 |
| 1861559551 | Geethalakshmi Mani | Family Medicine | 1601 Nw 114th Street, Suite 257, Clive, IA 50325-7036 | 2007-01-02 |
| 1679679831 | Timothy Allen Gerdis | Family Medicine | 1601 Nw 114th Street, Suite 255, Clive, IA 50325-7036 | 2006-09-15 |
| 1689781676 | Gary Bremen | Family Medicine | 1601 Nw 114th St, Clive, IA 50325-7007 | 2006-08-24 |
| Find all providers in CLIVE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.