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General NPI Number Information
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NPI Number | 1114912813
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE CLINIC PLC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 125 SCHOOL ST
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City | CARLISLE
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State | IA
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Zip | 50047-8702
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Country | US
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Telephone | 515-989-3221
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Fax | 515-989-4518
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Provider Business Mailing Address
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Address Line | 125 SCHOOL ST PO BOX F
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City | CARLISLE
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State | IA
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Zip | 50047-0705
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Country | US
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Telephone | 515-989-3221
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Fax | 515-989-4518
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. MICHAEL J MCCORMICK
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Credential | DO
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Telephone | 515-989-3221
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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 |
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License Number State |
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