Full Name | |
---|---|
Speciality | Clinic/center |
Location | 110 King Street, Fayette, Iowa |
Authorized Official Name and Position | Kari B Adank (CCO) |
Authorized Official Contact | 6087758025 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1836 South Ave La Crosse WI 54601-5429 Ph: (608) 782-7300 | 110 King Street Fayette IA 52142 Ph: (608) 782-7300 |
NPI Number | 1053366518 |
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Provider Enumeration Date | 05/23/2006 |
Last Update Date | 03/07/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053366518 | NPI | - | NPPES |
0638189 | Medicaid | IA |