Provider Demographics
NPI:1902800881
Name:MID-IOWA FERTILITY, P.C.
Entity Type:Organization
Organization Name:MID-IOWA FERTILITY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CMPE, CPC
Authorized Official - Phone:515-222-3060
Mailing Address - Street 1:1371 NW 121ST ST
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8143
Mailing Address - Country:US
Mailing Address - Phone:515-222-3060
Mailing Address - Fax:515-222-9563
Practice Address - Street 1:1371 NW 121ST ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8143
Practice Address - Country:US
Practice Address - Phone:515-222-3060
Practice Address - Fax:515-222-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center