Healthcare Provider Details

I. General information

NPI: 1083784771
Provider Name (Legal Business Name): WEBSTER CITY MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 COLLINS ST SUITE A
WEBSTER CITY IA
50595-2623
US

IV. Provider business mailing address

1610 COLLINS ST SUITE A
WEBSTER CITY IA
50595-2623
US

V. Phone/Fax

Practice location:
  • Phone: 515-832-6123
  • Fax: 515-832-3397
Mailing address:
  • Phone: 515-832-6123
  • Fax: 515-832-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19532
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1823
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20480
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1163
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1334
License Number StateIA

VIII. Authorized Official

Name: MS. PAULA CHUCHVARA
Title or Position: CEO
Credential: MS
Phone: 515-832-6123