WEST BROADWAY CLINIC P.C. NPI 1447641618

NPI Information

  • NPI: 1447641618
  • Provider Name: WEST BROADWAY CLINIC, P.C.
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Organization
  • CLIA Number: 16D1084332
  • Address: 1701 W BROADWAY
    COUNCIL BLUFFS, IA
    ZIP 51501
  • Phone: (712) 256-5600

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NPI Details

WEST BROADWAY CLINIC, P.C. is a medical physician assistant in Council Bluffs, IA. WEST BROADWAY CLINIC, P.C. NPI is 1447641618. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1701 W BROADWAY
COUNCIL BLUFFS, IA
ZIP 51501-822
Phone: (712) 256-5600
Fax: (712) 256-3440

The provider's authorized official is Stephanie K Lee .
The authorized official title is Physician Assistant and has the following contact phone number (712) 256-5600.

The CLIA number assigned to this NPI record is 16D1084332 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/10/2015 and was last updated on 2/16/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical076997IOWAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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