| West Broadway Clinic, Pc | |
|
16 S 17th St Council Bluffs IA 51501-3818 | |
| (712) 256-5600 | |
| Not Available |
| Full Name | West Broadway Clinic, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 16 S 17th St, Council Bluffs, Iowa |
| Authorized Official Name and Position | Isam Elias Marar (PRESIDENT) |
| Authorized Official Contact | 7122565600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Broadway Clinic, Pc 16 S 17th St Council Bluffs IA 51501-3818 Ph: (712) 256-5600 | West Broadway Clinic, Pc 16 S 17th St Council Bluffs IA 51501-3818 Ph: (712) 256-5600 |
| NPI Number | 1407031230 |
|---|---|
| Provider Enumeration Date | 12/28/2007 |
| Last Update Date | 12/28/2007 |
| Medicare PECOS PAC ID | 2961580667 |
|---|---|
| Medicare Enrollment ID | O20080422000254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407031230 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Diana J Rabadi Marar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366458945 PECOS PAC ID: 0840208849 Enrollment ID: I20060403000504 |
| Provider Name | Isam E Marar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104976109 PECOS PAC ID: 1658389655 Enrollment ID: I20060403000517 |
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