Full Name | |
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Speciality | Clinic/Center |
Location | 101 N Main St, George, Iowa |
Authorized Official Name and Position | Ronald Joseph Place (PRESIDENT/CEO) |
Authorized Official Contact | 6053227903 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 5045 Cbo Prv Enrmt Palm Place Sioux Falls SD 57117-5045 Ph: (605) 322-6428 | 101 N Main St George IA 51237 Ph: (712) 472-5300 |
NPI Number | 1790258044 |
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Provider Enumeration Date | 01/09/2019 |
Last Update Date | 10/13/2023 |
Medicare PECOS PAC ID | 0345157103 |
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Medicare Enrollment ID | O20190530001505 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790258044 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |