Healthcare Provider Details

I. General information

NPI: 1114912813
Provider Name (Legal Business Name): FAMILY PRACTICE CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SCHOOL ST
CARLISLE IA
50047-8702
US

IV. Provider business mailing address

125 SCHOOL ST PO BOX F
CARLISLE IA
50047-0705
US

V. Phone/Fax

Practice location:
  • Phone: 515-989-3221
  • Fax: 515-989-4518
Mailing address:
  • Phone: 515-989-3221
  • Fax: 515-989-4518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J MCCORMICK
Title or Position: OWNER PHYSICIAN
Credential: DO
Phone: 515-989-3221