Full Name | |
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Speciality | Clinic/Center |
Location | 104 S Main St, Garnavillo, Iowa |
Authorized Official Name and Position | Susan Stagman (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5632521121 |
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 550 Guttenberg IA 52052-0550 Ph: (563) 252-1121 | 104 S Main St Garnavillo IA 52049 Ph: (563) 252-1121 |
NPI Number | 1386996544 |
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Provider Enumeration Date | 10/11/2012 |
Last Update Date | 10/24/2024 |
Medicare PECOS PAC ID | 6901709476 |
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Medicare Enrollment ID | O20121121000256 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386996544 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |