Full Name | |
---|---|
Speciality | Family Medicine |
Location | 218 N 2nd St, Wapello, Iowa |
Authorized Official Name and Position | Philip E Roudabush (DIRECTOR, PATIENT FINANCIAL SERVICE) |
Authorized Official Contact | 3193842334 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
200 Hawkins Dr Iowa City IA 52242-1007 Ph: () - | 218 N 2nd St Wapello IA 52653-1202 Ph: (319) 523-8205 |
NPI Number | 1700834298 |
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Provider Enumeration Date | 05/05/2006 |
Last Update Date | 03/01/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700834298 | NPI | - | NPPES |
0175455 | Medicaid | IA | |
CG4344 | Other | IA | RR MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |