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General NPI Number Information
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NPI Number | 1104895044
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Entity Type | Organization
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Legal Business Name | DECATUR MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 802 ACKERLY ST
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City | LAMONI
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State | IA
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Zip | 50140-1544
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Country | US
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Telephone | 641-784-3371
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Fax | 641-784-6162
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Provider Business Mailing Address
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Address Line | 802 ACKERLY ST
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City | LAMONI
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State | IA
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Zip | 50140-1544
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Country | US
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Telephone | 641-784-3371
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Fax | 641-784-6162
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MARK E EASTER
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Credential | D.O.
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Telephone | 641-784-3371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02206
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License Number State | IA
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