# AEON GROUP HST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457600157
- **Authorized official:** PENNY T GRUNDER (PROJECT MANAGER)
- **Authorized official phone:** (563) 386-1904

## Contact information

- **Practice address:** 1801 E 54TH ST, SUITE 200, DAVENPORT, IA 52807-7209
- **Practice address phone:** (563) 386-1904
- **Practice address fax:** (866) 899-2592
- **Mailing address:** 1801 E 54TH ST, SUITE 200, DAVENPORT, IA 52807-7209
- **Mailing address phone:** (563) 386-1904
- **Mailing address fax:** (866) 899-2592

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | IA | Yes |

## Other

- **Enumeration date:** 09/10/2012
- **Last updated:** 09/10/2012