| Sac & Fox Of The Miss In Iowa | |
|
1646 305th Street Ste A Tama IA 52339-9634 | |
| (641) 484-4094 | |
| (641) 484-2432 |
| Full Name | Sac & Fox Of The Miss In Iowa |
|---|---|
| Speciality | Clinic/Center |
| Location | 1646 305th Street, Tama, Iowa |
| Authorized Official Name and Position | Mirza Gonzales (DIRECTOR ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 6414844094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sac & Fox Of The Miss In Iowa 1646 305th Street Tama IA 52339-9634 Ph: (641) 484-4094 | Sac & Fox Of The Miss In Iowa 1646 305th Street Ste A Tama IA 52339-9634 Ph: (641) 484-4094 |
| NPI Number | 1962618355 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 07/15/2014 |
| Medicare PECOS PAC ID | 6507806239 |
|---|---|
| Medicare Enrollment ID | O20050511000970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962618355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jerry L Wille |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598733891 PECOS PAC ID: 3678568466 Enrollment ID: I20040420000441 |
| Provider Name | Alicia D Barron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194888024 PECOS PAC ID: 3173568425 Enrollment ID: I20050627000978 |
| Provider Name | Melissa Diane Pearson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164481362 PECOS PAC ID: 3577570241 Enrollment ID: I20060321000653 |
| Provider Name | Sean J Mcmurray |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1548434400 PECOS PAC ID: 5890867253 Enrollment ID: I20080701000176 |
| Provider Name | Leighton E Frost |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053340661 PECOS PAC ID: 9638214067 Enrollment ID: I20100309000743 |
| Provider Name | Warangkana Chokesuwattanaskul |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1306030481 PECOS PAC ID: 4789717034 Enrollment ID: I20100806000357 |
| Provider Name | Larry M Newman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093141129 PECOS PAC ID: 9436387354 Enrollment ID: I20140122000585 |
| Provider Name | Anthony E Glydwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104251776 PECOS PAC ID: 6800023300 Enrollment ID: I20190111000082 |
| Provider Name | Adonica R Hennessy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699219857 PECOS PAC ID: 1355716242 Enrollment ID: I20230406000800 |
Mercycare Tama Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 402 Siegel St, Tama, IA 52339 Phone: 641-484-3333 Fax: 319-369-4677 |