Healthcare Provider Details

I. General information

NPI: 1679553770
Provider Name (Legal Business Name): CHARITON FAMILY MEDICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 7TH ST
CHARITON IA
50049-1210
US

IV. Provider business mailing address

1200 N 7TH ST PO BOX 571
CHARITON IA
50049-1210
US

V. Phone/Fax

Practice location:
  • Phone: 641-774-8103
  • Fax: 641-774-8087
Mailing address:
  • Phone: 641-774-8103
  • Fax: 641-774-8087

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: CATHY L HESTON
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 641-774-3108