Provider Demographics
NPI:1790868057
Name:DR ROBERT EELLS PC
Entity type:Organization
Organization Name:DR ROBERT EELLS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:EELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-244-0633
Mailing Address - Street 1:1111 E ARMY POST RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-5970
Mailing Address - Country:US
Mailing Address - Phone:515-244-0633
Mailing Address - Fax:515-244-2412
Practice Address - Street 1:1111 E ARMY POST RD
Practice Address - Street 2:SUITE 470
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-5970
Practice Address - Country:US
Practice Address - Phone:515-244-0633
Practice Address - Fax:515-244-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00571332B00000X, 332BC3200X, 261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0176941Medicaid
IACI3648Medicare PIN
IA1249930001Medicare NSC
IA0176941Medicaid