| Family Medicine Clinic, Pc | |
|
1614 Diamond Street Pl Onawa IA 51040-1554 | |
| (712) 423-1525 | |
| (712) 423-2528 |
| Full Name | Family Medicine Clinic, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1614 Diamond Street Pl, Onawa, Iowa |
| Authorized Official Name and Position | Paul Edward Dudley (PRESIDENT) |
| Authorized Official Contact | 7124231525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Clinic, Pc 1614 Diamond Street Pl Onawa IA 51040-1554 Ph: (712) 423-1525 | Family Medicine Clinic, Pc 1614 Diamond Street Pl Onawa IA 51040-1554 Ph: (712) 423-1525 |
| NPI Number | 1063418820 |
|---|---|
| Provider Enumeration Date | 06/24/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0547159824 |
|---|---|
| Medicare Enrollment ID | O20060804000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063418820 | NPI | - | NPPES |
| CQ2293 | Other | IA | RAILROAD MEDICARE |
| 0638312 | Medicaid | IA | |
| 63831 | Other | IA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Iowa) | Primary |
Family Medicine Clinic, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1614 Diamond Street Pl, Onawa, IA 51040 Phone: 712-423-1525 Fax: 712-423-2528 |