Active NPI
Greg Robert Peterson
- Non-emergency Medical Transport (VAN)
- Davenport, IA
National Provider Identifier
1154847069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Non-emergency Medical Transport (VAN)
- License
- 580AH7464
- Practice address
- 2723 E 29TH CT
Davenport, IA 52803-2112 - Phone
- (563) 370-7061
- Fax
- (563) 421-6099
- NPI assigned
- Aug 22, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-emergency Medical Transport (VAN) | 343900000X | 580AH7464 | IA | Primary |
Addresses
Primary practice location
2723 E 29TH CT
Davenport, IA 52803-2112
Mailing address
2723 E 29TH CT
Davenport, IA 52803-2112
Phone (563) 370-7061
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 580AH7464 | IA | MD | Non-emergency Medical Transport (VAN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1154847069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2723 E 29TH CT",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528032112",
"telephone_number": "563-370-7061",
"fax_number": "563-421-6099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2723 E 29TH CT",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528032112",
"telephone_number": "563-370-7061",
"fax_number": "563-421-6099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "GREG",
"middle_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-22",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": "IA",
"license": "580AH7464",
"primary": true
}
],
"identifiers": [],
"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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.