NPIMap

Organization Active NPI

Physicians Laboratory of Northwest Iowa LTD

  • Anatomic Pathology & Clinical Pathology Physician
  • Spencer, IA
National Provider Identifier
1043452238
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PHYSICIANS LABORATORY OF NORTHWEST IOWA LTD
Practice address
116 E 11TH St
Suite 204
Spencer, IA 51301-4364
Phone
(712) 262-3795
Fax
(712) 262-3076
NPI assigned
Apr 2, 2009
Last updated
Sep 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Authorized official

Name
Mr. Lee Brandt
Title
Administrator
Phone
(605) 322-7208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X IA Primary

Addresses

Primary practice location

116 E 11TH St
Suite 204
Spencer, IA 51301-4364

Mailing address

116 E 11TH St
Suite 204
Spencer, IA 51301-4364
Phone (712) 262-3795

Other names 1

  • PHYSICIANS LABORATORY OF NWIA Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100217000785 IA Part B Supplier - Clinic/Group Practice 9537058458 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Spencer, IA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1043452238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 E 11TH ST",
            "address_2": "SUITE 204",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014364",
            "telephone_number": "712-262-3795",
            "fax_number": "712-262-3076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E 11TH ST",
            "address_2": "SUITE 204",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014364",
            "telephone_number": "712-262-3795",
            "fax_number": "712-262-3076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS LABORATORY OF NORTHWEST IOWA LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-02",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "BRANDT",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-322-7208",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIANS LABORATORY OF NWIA",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PHYSICIANS LABORATORY OF NWIA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Spencer, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.