West Broadway Clinic, P.C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

076849 Issued in IA

Legal business name

WEST BROADWAY CLINIC, P.C.

Practice address

1701 W Broadway
Council Bluffs, IA 51501-3822

Phone

(712) 256-5600

Fax

(712) 256-3440

NPI assigned

Feb 11, 2015

Organization subpart

No

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

Authorized official

Name

Kimberly N Spencer, PA-C

Title

Physician Assistant

Phone

(712) 256-5600

Specialties & licenses 1

Addresses

Tax ID family

West Broadway Clinic PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• West Broadway Clinic, P.C.

  • Medical Physician Assistant
  • Council Bluffs, IA
  • NPI 1447641618
  NPD tax ID

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424044800000",
    "number": "1457742587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013822",
            "telephone_number": "712-256-5600",
            "fax_number": "712-256-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013822",
            "telephone_number": "712-256-5600",
            "fax_number": "712-256-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST BROADWAY CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-16",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "712-256-5600",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "076849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgia Ann Welch, HIS
• Rachel Lynn Wellman, ARNP
• Lavaughn Wells
• Melanie Jo Wells, LISW, LMSW
• West Broadway Clinic, P.C.
• West Broadway Clinic, PC
• Gina West-Hendrickson
• Western Iowa Dental Group, LLC
• Western Iowa Dental Group,PC
• Sheila Mary Wettengel, RPH

• Medical Physician Assistant in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Medical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; 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.