Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 321 Main St, Sanborn, Iowa |
Authorized Official Name and Position | Joel Mason Gustafson (ADMINISTRATOR) |
Authorized Official Contact | 7123245356 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
321 Main St P.o. Box 400 Sanborn IA 51248-0400 Ph: (712) 729-3545 | 321 Main St Sanborn IA 51248-0400 Ph: (712) 729-3545 |
NPI Number | 1144302191 |
---|---|
Provider Enumeration Date | 10/19/2006 |
Last Update Date | 11/27/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144302191 | NPI | - | NPPES |
0638593 | Medicaid | IA | |
0254656 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |