| Waterford Family Medicine Pc | |
|
1820 E 54th St Ste B Davenport IA 52807-2797 | |
| (563) 355-9990 | |
| (563) 355-9999 |
| Full Name | Waterford Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1820 E 54th St, Davenport, Iowa |
| Authorized Official Name and Position | Tammy J Wells (OWNER) |
| Authorized Official Contact | 5633559990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waterford Family Medicine Pc 1820 E 54th St Ste B Davenport IA 52807-2797 Ph: (563) 355-9990 | Waterford Family Medicine Pc 1820 E 54th St Ste B Davenport IA 52807-2797 Ph: (563) 355-9990 |
| NPI Number | 1942470828 |
|---|---|
| Provider Enumeration Date | 03/06/2008 |
| Last Update Date | 03/06/2008 |
| Medicare PECOS PAC ID | 1557335809 |
|---|---|
| Medicare Enrollment ID | O20040823000753 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942470828 | NPI | - | NPPES |
| 49490 | Other | IA | BLUE SHIELD |
| 7100883 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1093794968 (Iowa) | Primary |
| Provider Name | Alisa A Paisley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891801916 PECOS PAC ID: 6406901651 Enrollment ID: I20090911000396 |
| Provider Name | Cammie Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518054436 PECOS PAC ID: 8022150051 Enrollment ID: I20100128000610 |
| Provider Name | Tammy J Wells |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093794968 PECOS PAC ID: 5698820843 Enrollment ID: I20100216000068 |
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