Radiant Complexions Dermatology Clinic of Council Bluffs, PLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

RADIANT COMPLEXIONS DERMATOLOGY CLINIC OF COUNCIL BLUFFS, PLC

Practice address

900 Woodbury Ave
Suite 5B
Council Bluffs, IA 51503-7847

Phone

(712) 352-2678

Fax

(888) 557-0763

NPI assigned

May 19, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Charles W Love, M.D.NPI 1043312432

Title

Owner

Phone

(515) 226-8484

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles W Love, MD

  • Dermatology Physician
  • West Des Moines, IA
  • NPI 1043312432
  NPD (past) Authorized official

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

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445299200000",
    "number": "1942593264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WOODBURY AVE",
            "address_2": "SUITE 5B",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515037847",
            "telephone_number": "712-352-2678",
            "fax_number": "888-557-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WOODBURY AVE",
            "address_2": "SUITE 5B",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515037847",
            "telephone_number": "712-352-2678",
            "fax_number": "888-557-0763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT COMPLEXIONS DERMATOLOGY CLINIC OF COUNCIL BLUFFS, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-19",
        "last_updated": "2015-10-20",
        "status": "A",
        "authorized_official_last_name": "LOVE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-226-8484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pulmonary Infectious Disease Associates PC
• Joseph Quattrocchi Jr., D.D.S.
• Christy Michelle Quillen, ARNP
• Laura Quinnette, PA-C
• Diana Jeries Rabadi-Marar, M.D.
• Rebekah Ramirez
• Amanda Lynn Randolph, PLMHP
• Brenna L Rasmussen
• Edward Aaron Rastovski, PHARM.D.
• Anna Read, PA-C

• Dermatology Physician in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Dermatology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.