| Chariton Valley Medical Center Pc | |
|
707 S Main Centerville IA 52544-2421 | |
| (641) 437-4344 | |
| (641) 856-5410 |
| Full Name | Chariton Valley Medical Center Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 707 S Main, Centerville, Iowa |
| Authorized Official Name and Position | Stephen S Jewett (OWNER) |
| Authorized Official Contact | 6414374344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chariton Valley Medical Center Pc Po Box 100 707 S Main Centerville IA 52544-2421 Ph: (641) 437-4344 | Chariton Valley Medical Center Pc 707 S Main Centerville IA 52544-2421 Ph: (641) 437-4344 |
| NPI Number | 1902868664 |
|---|---|
| Provider Enumeration Date | 04/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0840180592 |
|---|---|
| Medicare Enrollment ID | O20040317000852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902868664 | NPI | - | NPPES |
| 3130443 | Medicaid | IA | |
| 0024141 | Medicaid | IA | |
| 1110031 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 17554 (Iowa) | Secondary |
| 207Q00000X | Family Medicine | 30574 (Iowa) | Secondary |
| 207Q00000X | Family Medicine | 01603 (Iowa) | Primary |
| Provider Name | Kathleen Anne Lange |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811085848 PECOS PAC ID: 2163512393 Enrollment ID: I20081217000661 |
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