| John M. Ippolito Md, P.c | |
|
201 Ridge St Suite 301 Council Bluffs IA 51503-4643 | |
| (712) 256-0791 | |
| (712) 256-0807 |
| Full Name | John M. Ippolito Md, P.c |
|---|---|
| Speciality | Internal Medicine |
| Location | 201 Ridge St, Council Bluffs, Iowa |
| Authorized Official Name and Position | John M Ippolito (PRESIDENT) |
| Authorized Official Contact | 7122560791 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John M. Ippolito Md, P.c 201 Ridge St Suite 301 Council Bluffs IA 51503-4643 Ph: (712) 256-0791 | John M. Ippolito Md, P.c 201 Ridge St Suite 301 Council Bluffs IA 51503-4643 Ph: (712) 256-0791 |
| NPI Number | 1548310394 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 04/24/2013 |
| Medicare PECOS PAC ID | 9335035054 |
|---|---|
| Medicare Enrollment ID | O20040227000370 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548310394 | NPI | - | NPPES |
| 1044065 | Medicaid | IA | |
| 1548310394 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25954 (Iowa) | Primary |
| Provider Name | John M Ippolito |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215929708 PECOS PAC ID: 1052207776 Enrollment ID: I20040227000428 |
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