Organization
PULMONARY INFECTIOUS DISEASE ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LESLIE A SOUTHARD (OFC MGR ASSISTANT SEC TREAS)
(712) 366-5709
Entity
Organization
Contact information
Practice address
1 EDMUNDSON PL, SUITE 312, COUNCIL BLUFFS, IA 51503-4658
(712) 396-4295
(712) 396-4298
Mailing address
1 EDMUNDSON PL, SUITE 312, COUNCIL BLUFFS, IA 51503-4658
(712) 396-4295
(712) 396-4298
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0297150
—
IA
Enumeration date
02/12/2007
Last updated
08/22/2020
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