Impactlife

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

16D0387118 Issued in IA

Legal business name

IMPACTLIFE

Practice address

5500 Lakeview Pkwy
Davenport, IA 52807-3481

Phone

(563) 359-5401

NPI assigned

Jan 31, 2006

Last updated

Aug 4, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Darren Klocke

Title

Cfo

Phone

(563) 823-4109

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MIssissippi Valley Regional Blood Center Former legal business name

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1821069493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 LAKEVIEW PARKWAY",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "52807",
            "telephone_number": "563-359-5401",
            "fax_number": "563-823-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 LAKEVIEW PKWY",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073481",
            "telephone_number": "563-359-5401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6330 Copps Ave",
            "address_purpose": "LOCATION",
            "city": "Monona",
            "state": "WI",
            "postal_code": "537163719",
            "country_code": "US",
            "telephone_number": "563-359-5401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1408 W University Ave",
            "address_purpose": "LOCATION",
            "city": "Urbana",
            "state": "IL",
            "postal_code": "618012341",
            "country_code": "US",
            "telephone_number": "563-359-5401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3420 Rider Trl S",
            "address_purpose": "LOCATION",
            "city": "Earth City",
            "state": "MO",
            "postal_code": "630451100",
            "country_code": "US",
            "telephone_number": "563-359-5401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 S 10th St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627033949",
            "country_code": "US",
            "telephone_number": "563-359-5401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACTLIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "KLOCKE",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "563-823-4109"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IA",
            "license": "16D0387118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0243113",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIssissippi Valley Regional Blood Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Ideal Health and Wellness, SC (Ideal Health and Wellness, SC, Corp)
• David R Iglehart, DDS
• Olaitan Atinuke Ijitimehin, MD
• Ali Ilahi, MD
• Robert A. Illingworth, D.C.
• Infectious Diseases Associates
• Innate Chiropractic, PLC
• Inner Health Chiropractic, P. L.L.C.
• Inner Health Systems P.C. (Inner Health Chiropractic)
• Inside Out Counseling and Consulting LLC

• Clinical Medical Laboratory in Davenport, IA
• Providers in Davenport, IA by specialty
• Clinical Medical Laboratory in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.