| Family Medicine Clinic, P.c. | |
|
1614 Diamond Street Pl Onawa IA 51040-1554 | |
| (712) 423-1525 | |
| (712) 423-2528 |
| Full Name | Family Medicine Clinic, P.c. |
|---|---|
| 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, P.c. 1614 Diamond Street Pl Onawa IA 51040-1554 Ph: (712) 423-1525 | Family Medicine Clinic, P.c. 1614 Diamond Street Pl Onawa IA 51040-1554 Ph: (712) 423-1525 |
| NPI Number | 1386824787 |
|---|---|
| Provider Enumeration Date | 11/14/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0547159824 |
|---|---|
| Medicare Enrollment ID | O20040313000752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386824787 | NPI | - | NPPES |
| 06420 | Other | IA | BLUE SHIELD |
| 0064204 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Iowa) | Primary |
| Provider Name | Tracy Lee Kahl |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104812783 PECOS PAC ID: 6901874270 Enrollment ID: I20040923000916 |
| Provider Name | Paul E Dudley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194721332 PECOS PAC ID: 8820091119 Enrollment ID: I20090218000447 |
| Provider Name | Brandon L Kovar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154529725 PECOS PAC ID: 4082748652 Enrollment ID: I20100818000323 |
| Provider Name | Shannon R Kennedy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497720197 PECOS PAC ID: 7113041054 Enrollment ID: I20100830001105 |
| Provider Name | Allison L Kovar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942468111 PECOS PAC ID: 5496925984 Enrollment ID: I20110818000552 |
| Provider Name | Kathryn R Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093120826 PECOS PAC ID: 8325265911 Enrollment ID: I20140805001365 |
| Provider Name | Lisa A. Pape |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578072351 PECOS PAC ID: 7810263225 Enrollment ID: I20171030000991 |
| Provider Name | Ashton M Pruett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851889117 PECOS PAC ID: 0840548343 Enrollment ID: I20180731001713 |
| Provider Name | Jessica L Renz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538713532 PECOS PAC ID: 6305272360 Enrollment ID: I20200211001277 |
Family Medicine Clinic, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1614 Diamond Street Pl, Onawa, IA 51040 Phone: 712-423-1525 Fax: 712-423-2528 |