WEST BROADWAY CLINIC P.C. NPI 1447641618

NPI Information

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:

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