Organization Active NPI

Dermatology and Dermatologic Surgery Center, PC

  • Dermatology Physician
  • Clive, IA
National Provider Identifier
1285792788
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY AND DERMATOLOGIC SURGERY CENTER, PC
Practice address
8131 University Blvd
Clive, IA 50325-1123
Phone
(515) 225-8180
Fax
(515) 225-2041
NPI assigned
Dec 5, 2006
Last updated
Apr 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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

Authorized official

Name
Ms. Dee Marie Knoke
Title
Office Manager
Phone
(515) 225-8180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X IA Primary

Addresses

Primary practice location

8131 University Blvd
Clive, IA 50325-1123

Mailing address

8131 University Blvd
Clive, IA 50325-1123
Phone (515) 225-8180

National Provider Directory

National Provider Directory

Locations

1610 W Townline St
Creston, IA 50801
Phone (641) 782-2131

8131 University Blvd
Des Moines, IA 50325
Phone (515) 225-8180

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397606400000",
    "number": "1285792788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8131 UNIVERSITY BLVD",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503251123",
            "telephone_number": "515-225-8180",
            "fax_number": "515-225-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8131 UNIVERSITY BLVD",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503251123",
            "telephone_number": "515-225-8180",
            "fax_number": "515-225-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND DERMATOLOGIC SURGERY CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2014-04-16",
        "status": "A",
        "authorized_official_last_name": "KNOKE",
        "authorized_official_first_name": "DEE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "515-225-8180",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2014; 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.