Full Name | |
---|---|
Speciality | Family Medicine |
Location | 616 10th St, Perry, Iowa |
Authorized Official Name and Position | Kenneth L Fisher (CFO) |
Authorized Official Contact | 3193842844 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2941 Sierra Ct Sw Iowa City IA 52240-8503 Ph: () - | 616 10th St Perry IA 50220-2221 Ph: (515) 465-3553 |
NPI Number | 1013965334 |
---|---|
Provider Enumeration Date | 05/05/2006 |
Last Update Date | 07/07/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013965334 | NPI | - | NPPES |
0280040 | Medicaid | IA | |
33267 | Other | IA | WELLMARK |
CK8851 | Other | IA | RR MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |