Healthcare Provider Details

I. General information

NPI: 1952381360
Provider Name (Legal Business Name): CHARLES CITY FAMILY HEALTH CTR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S MAIN ST SUITE 1
CHARLES CITY IA
50616-3444
US

IV. Provider business mailing address

1501 S MAIN ST SUITE 1
CHARLES CITY IA
50616-3444
US

V. Phone/Fax

Practice location:
  • Phone: 641-228-5151
  • Fax: 641-228-2902
Mailing address:
  • Phone: 641-228-5151
  • Fax: 641-228-2902

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: VICKIE DEMRO
Title or Position: OFFICE MANAGER
Credential:
Phone: 641-228-5151