MEDICARE: LANTERN FAMILY MEDICINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	38644	IA

General Provider Information

NPI Number	:	1053772202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANTERN FAMILY MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 250
Second Line	:
City	:	BONAPARTE
State	:	IA
Zip	:	52620-0250
Country	:	US
Telephone Number	:	319-677-0219
Fax Number	:	888-965-5450

Provider Business Practice Location Address
First Line	:	602 8TH ST STE 105
Second Line	:
City	:	BONAPARTE
State	:	IA
Zip	:	52620-9769
Country	:	US
Telephone Number	:	319-677-0219
Fax Number	:	888-965-5450

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	AMANDA JEAN GERBER
Credential	:	MD
Telephone Number	:	319-677-0219

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	03/17/2018

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