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Contact Information

THERESA MACDISSI, P.A.-C
1 EDMUNDSON PL STE 306
COUNCIL BLUFFS, IA51503
 Phone: 712-396-7787
 Fax: 712-396-4115
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for THERESA MACDISSI · (Female)

NPI # 1164840617
Status Active
Credentials P.A.-C
Entity Individual
Enumeration date 04/02/2014
Last updated 06/18/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IA License # 092083
  • NE License # 1802
  • IA Medicaid 1164840617
  • NE Medicaid 47068731713
Hospital affiliation(s)
  • JENNIE EDMUNDSON HOSPITAL - (Acute Care)
    933 EAST PIERCE STREET
    COUNCIL BLUFFS, IA 51503
  • MONTGOMERY COUNTY MEMORIAL HOSPITAL - (Critical Access)
    2301 EASTERN AVENUE
    RED OAK, IA 51566
  • MYRTUE MEDICAL CENTER - (Critical Access)
    1213 GARFIELD AVENUE
    HARLAN, IA 51537
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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