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General NPI Number Information
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NPI Number | 1740232842
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Entity Type | Organization
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Legal Business Name | CRESTON MEDICAL CLINIC, P.C.
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 1610 W TOWNLINE ST SUITE 200
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City | CRESTON
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State | IA
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Zip | 50801-1066
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Country | US
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Telephone | 641-782-2131
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Fax | 641-782-6425
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Provider Business Mailing Address
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Address Line | 1610 W TOWNLINE ST SUITE 200
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City | CRESTON
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State | IA
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Zip | 50801-1066
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Country | US
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Telephone | 641-782-2131
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Fax | 641-782-6425
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Authorized Official
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Title or Position | PRESIDENT OF THE CORPORATION
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Name | DR. JAMES E MANSOUR
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Credential | M.D.
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Telephone | 641-782-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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