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Organization

CRESTON MEDICAL CLINIC, P.C.

Active
Other names
Creston Medical Clinic CRNAs
Organization subpart
No

Provider details

NPI number
Authorized official
JAMES E MANSOUR M.D. (PRESIDENT OF THE CORPORATION)
(641) 782-2131
Entity
Organization

Contact information

Practice address
1610 W TOWNLINE ST, SUITE 200, CRESTON, IA 50801-1066
(641) 782-2131
(641) 782-6425
Mailing address
1610 W TOWNLINE ST, SUITE 200, CRESTON, IA 50801-1066
(641) 782-2131
(641) 782-6425

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0265793
IA
01
26579
WELLMARK BCBS CRNA #
IA
Enumeration date
05/20/2006
Last updated
08/22/2020
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