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220 Mulberry St Wapello IA 52653-1570 | |
(319) 768-4085 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 220 Mulberry St, Wapello, Iowa |
Authorized Official Name and Position | Tony Hayes (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 3197681000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 540 West Burlington IA 52655-0540 Ph: (319) 768-3450 | 220 Mulberry St Wapello IA 52653-1570 Ph: (319) 768-4085 |
NPI Number | 1679613723 |
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Provider Enumeration Date | 02/07/2007 |
Last Update Date | 02/19/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679613723 | NPI | - | NPPES |
0638494 | Medicaid | IA | |
CH9435 | Other | IA | RR MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |