Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 600 Busti Ave, Elma, Iowa |
Authorized Official Name and Position | Brandon Brevig (CFO) |
Authorized Official Contact | 5635476677 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
235 8th Ave W Cresco IA 52136-1062 Ph: (563) 547-2101 | 600 Busti Ave Elma IA 50628-8090 Ph: (000) 000-0000 |
NPI Number | 1104440809 |
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Provider Enumeration Date | 05/29/2020 |
Last Update Date | 02/07/2024 |
Medicare PECOS PAC ID | 1153238977 |
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Medicare Enrollment ID | O20201020000986 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104440809 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |