| Tanager Place | |
|
2309 C St Sw Cedar Rapids IA 52404-3707 | |
| (319) 365-9164 | |
| (319) 365-6411 |
| Full Name | Tanager Place |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2309 C St Sw, Cedar Rapids, Iowa |
| Authorized Official Name and Position | Jeff Humiston (C.F.O.) |
| Authorized Official Contact | 3193659165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanager Place 2309 C St Sw Cedar Rapids IA 52404-3707 Ph: (319) 365-9164 | Tanager Place 2309 C St Sw Cedar Rapids IA 52404-3707 Ph: (319) 365-9164 |
| NPI Number | 1053467423 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053467423 | NPI | - | NPPES |
| 38468 | Other | IA | WELLMARK PROVIDER # |
| 0427054 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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