Provider Demographics
NPI:1053690917
Name:PLANNED PARENTHOOD OF THE HEARTLAND
Entity type:Organization
Organization Name:PLANNED PARENTHOOD OF THE HEARTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-698-2406
Mailing Address - Street 1:671 VANDALIA ST
Mailing Address - Street 2:ATTN: PPH
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1312
Mailing Address - Country:US
Mailing Address - Phone:877-811-7526
Mailing Address - Fax:515-280-9525
Practice Address - Street 1:1626 MORGAN ST
Practice Address - Street 2:PLANNED PARENTHOOD OF THE HEARTLAND KEOKUK CLINIC
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3420
Practice Address - Country:US
Practice Address - Phone:319-524-2759
Practice Address - Fax:319-524-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33019363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAGROUP0057570Medicaid
IAH00650Medicare UPIN