Mine

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

483062595 Issued in IA

Legal business name

MINE

Practice address

2 SW 9TH St
316
Des Moines, IA 50309-4310

Phone

(515) 729-9350

NPI assigned

Apr 17, 2017

Organization subpart

Yes

Parent organization

YTUKJTYKJTAs reported in NPPES

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

Authorized official

Name

Mr. Robert Dean Forkner III, UI

Title

Myself

Phone

(515) 729-9350

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SELF Doing business as

Locations

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492387200000",
    "number": "1760916779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 S.W. 9TH STREET",
            "address_2": "316",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503091234",
            "telephone_number": "515-729-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SW 9TH ST",
            "address_2": "316",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503094310",
            "telephone_number": "515-729-9350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YTUKJTYKJT",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A",
        "authorized_official_last_name": "FORKNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MYSELF",
        "authorized_official_telephone_number": "515-729-9350",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "UI"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "IA",
            "license": "483062595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "483062595",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SELF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Renea Miller, LPN
• Tiffani Lynn Milless, M.D.
• Kelsey Millonig, DPM, MPH
• Hamzah Miltaha, M.D.
• Mindful Mental Health Counseling LLC
• Jennifer Lynn Miner, LISW
• Kaitlyn Miner, DO
• Zach Miner, MD
• Matthew Minnick, PHARMD
• Juan Camilo Mira, M.D.

• Health Maintenance Organization in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Health Maintenance Organization in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; 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.