Southammavong, Mindy Baccam

Southammavong, Mindy Baccam is an individual health care provider with primary practice located at 405 Monroe St , Pella IA 50219-1189. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Southammavong, Mindy Baccam can be contacted via phone (641) 621-2200.

Contact Information

Primary practice address
405 Monroe St Pella IA 50219-1189
Phone: (641) 621-2200
Fax: (641) 621-2335
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 078982 Iowa

Profile Details

NPI number 1528434859
LBN Legal business name Southammavong, Mindy Baccam
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2015
Last updated May 1st, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528434859 NPPES
Iowa Other 1528434859 NPI NUMBER
Iowa Other 078982 NPI NUMBER

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