Provider Demographics
NPI:1548551237
Name:DES MOINES CARDIOLOGY, PC
Entity type:Organization
Organization Name:DES MOINES CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LATCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:515-528-8186
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1540 HIGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3106
Practice Address - Country:US
Practice Address - Phone:515-528-8186
Practice Address - Fax:515-528-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1548551237Medicaid
IAIB2171Medicare PIN