Healthcare Provider Details

I. General information

NPI: 1942516471
Provider Name (Legal Business Name): RED HAW FAMILY MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N 7TH ST
CHARITON IA
50049-1206
US

IV. Provider business mailing address

1030 N 7TH ST PO BOX 674
CHARITON IA
50049-1206
US

V. Phone/Fax

Practice location:
  • Phone: 641-217-9115
  • Fax: 641-217-9137
Mailing address:
  • Phone: 641-217-9115
  • Fax: 641-217-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37367
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37367
License Number StateIA

VIII. Authorized Official

Name: DR. PHILIP DEWAIN SUNDQUIST
Title or Position: FAMILY PRACTICE/OBGYN
Credential: M.D.
Phone: 641-217-9115