Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 100 S Main St, Lenox, Iowa |
Authorized Official Name and Position | Matthew L Mccutchan (CFO) |
Authorized Official Contact | 6417823899 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1700 W Townline St Creston IA 50801-1054 Ph: (641) 782-7091 | 100 S Main St Lenox IA 50851-1240 Ph: (641) 333-4545 |
NPI Number | 1346353323 |
---|---|
Provider Enumeration Date | 08/16/2006 |
Last Update Date | 04/24/2013 |
Medicare PECOS PAC ID | 9234041013 |
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Medicare Enrollment ID | O20090918000499 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346353323 | NPI | - | NPPES |
0634691 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |