NPIMap

Organization Active NPI

Pleasantville Clinic

  • Non-Pharmacy Dispensing Site
  • Pleasantville, IA
National Provider Identifier
1578735429
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
PLEASANTVILLE CLINIC
Practice address
104 N Washington St
Pleasantville, IA 50225-9312
Phone
(952) 653-2525
NPI assigned
Apr 1, 2008
Last updated
Apr 1, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PLEASANTVILLE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Authorized official

Name
Brandi BoothNPI 1821071515
Title
Clinic Director
Phone
(952) 653-2525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

104 N Washington St
Pleasantville, IA 50225-9312

Mailing address

6501 City West Pkwy
Eden Prairie, MN 55344-3248

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0383105Pleasantville Clinic104 North Washington Street, PO Box 574, Pleasantville, IA 50225Certificate of waiverSep 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Knoxville Community Hospital Inc8 organizations share this tax ID, including this one
Part of
Knoxville Community Hospital Inc

Other organizations with this tax ID 7

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

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": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1578735429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N WASHINGTON ST",
            "city": "PLEASANTVILLE",
            "state": "IA",
            "postal_code": "502259312",
            "telephone_number": "952-653-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLEASANTVILLE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PLEASANTVILLE CLINIC",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "952-653-2525"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasantville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.