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General NPI Number Information
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NPI Number | 1386727204
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Entity Type | Organization
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Legal Business Name | MADISON COUNTY MEDICAL ASSOC, PC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 60 E COURT AVE
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City | WINTERSET
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State | IA
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Zip | 50273-1517
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Country | US
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Telephone | 515-462-1162
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Fax | 515-462-2331
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Provider Business Mailing Address
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Address Line | PO BOX 192
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City | WINTERSET
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State | IA
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Zip | 50273-0192
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Country | US
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Telephone | 515-462-1162
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Fax | 515-462-2331
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN VINCENT DE REGNIER
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Credential | DO
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Telephone | 515-462-1162
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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 | 02175
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License Number State | IA
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