| |
301 East Street Shelby IA 51570-3319 | |
(712) 544-2511 | |
(712) 544-2512 |
Full Name | |
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Speciality | Clinic/Center |
Location | 301 East Street, Shelby, Iowa |
Authorized Official Name and Position | Barry A. Jacobsen (CEO) |
Authorized Official Contact | 7127554315 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1213 Garfield Ave Harlan IA 51537-2057 Ph: (712) 755-5161 | 301 East Street Shelby IA 51570-3319 Ph: (712) 544-2511 |
NPI Number | 1316054034 |
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Provider Enumeration Date | 08/25/2006 |
Last Update Date | 12/14/2010 |
Medicare PECOS PAC ID | 5193619393 |
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Medicare Enrollment ID | O20051004000873 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316054034 | NPI | - | NPPES |
0685131 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |