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400 Canton St Nw Ste B Shellsburg IA 52332-9645 | |
(319) 436-2040 | |
(319) 436-2027 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 400 Canton St Nw, Shellsburg, Iowa |
Authorized Official Name and Position | Erick J Laine (COO) |
Authorized Official Contact | 5154719227 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8101 Birchwood Court Suite R Johnston IA 50131-2930 Ph: (515) 471-9243 | 400 Canton St Nw Ste B Shellsburg IA 52332-9645 Ph: (319) 436-2040 |
NPI Number | 1245288661 |
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Provider Enumeration Date | 05/05/2006 |
Last Update Date | 08/15/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245288661 | NPI | - | NPPES |
0689083 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |