| Primary Health Care-east Side Clinic | |
|
3509 E 29th St Des Moines IA 50317-4253 | |
| (515) 248-1600 | |
| (515) 248-1610 |
| Full Name | Primary Health Care-east Side Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 3509 E 29th St, Des Moines, Iowa |
| Authorized Official Name and Position | Kelly Huntsman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5152481441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Health Care-east Side Clinic 1200 University Ave Suite 200 Des Moines IA 50314-2355 Ph: (515) 248-1447 | Primary Health Care-east Side Clinic 3509 E 29th St Des Moines IA 50317-4253 Ph: (515) 248-1600 |
| NPI Number | 1124177407 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 09/23/2016 |
| Medicare PECOS PAC ID | 8426966755 |
|---|---|
| Medicare Enrollment ID | O20030203000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124177407 | NPI | - | NPPES |
| 0281857 | Medicaid | IA | |
| 35586 | Other | IA | WELLMARK BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | NA (Iowa) | Primary |
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