Full Name | |
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Speciality | Clinic/Center |
Location | 1800 Main St, Gowrie, Iowa |
Authorized Official Name and Position | James L Henkenius (CFO) |
Authorized Official Contact | 7124644200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1301 W Main St Lake City IA 51449-1585 Ph: (712) 464-3171 | 1800 Main St Gowrie IA 50543-7438 Ph: (712) 464-8891 |
NPI Number | 1588690267 |
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Provider Enumeration Date | 06/24/2006 |
Last Update Date | 03/05/2024 |
Certification Date | 03/05/2024 |
Medicare PECOS PAC ID | 4486563707 |
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Medicare Enrollment ID | O20050105000264 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588690267 | NPI | - | NPPES |