Organization Active NPI

Renee D Lass

  • Family Medicine Physician
  • Davenport, IA
National Provider Identifier
1043228604
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3589 Issued in IA
Legal business name
RENEE D LASS
Practice address
4626 Progress Dr Ste B
Davenport, IA 52807-3485
Phone
(563) 359-3736
Fax
(563) 359-0153
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Pam Bell
Title
Office MGR
Phone
(563) 359-3736

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 3589 IA Primary

Addresses

Primary practice location

4626 Progress Dr Ste B
Davenport, IA 52807-3485

Mailing address

4626 Progress Dr Ste B
Davenport, IA 52807-3485
Phone (563) 359-3736

Other identifiers 1

IdentifierTypeStateIssuer
3444885MedicaidIA

National Provider Directory

National Provider Directory

Locations

4626 Progress Dr
Ste B
Davenport, IA 52807
Phone (563) 296-7730

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1043228604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 PROGRESS DR STE B",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073485",
            "telephone_number": "563-359-3736",
            "fax_number": "563-359-0153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 PROGRESS DR STE B",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073485",
            "telephone_number": "563-359-3736",
            "fax_number": "563-359-0153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEE D LASS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OFFICE MGR",
        "authorized_official_telephone_number": "563-359-3736"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "3589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3444885",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.