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503 3rd Ave Sw State Center IA 50247-7719 | |
(641) 483-2141 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 503 3rd Ave Sw, State Center, Iowa |
Authorized Official Name and Position | Robert L. Downey (VICE PRESIDENT OF FINANCE) |
Authorized Official Contact | 6417545125 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3 South 4th Avenue Marshalltown IA 50158-2998 Ph: (641) 754-5151 | 503 3rd Ave Sw State Center IA 50247-7719 Ph: (641) 483-2141 |
NPI Number | 1891771663 |
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Provider Enumeration Date | 12/22/2005 |
Last Update Date | 12/03/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891771663 | NPI | - | NPPES |
0685214 | Medicaid | IA | |
47411 | Other | IA | BLUE SHIELD OF IOWA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |