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General NPI Number Information
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NPI Number | 1902269632
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Entity Type | Organization
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Legal Business Name | PRAIRIE CITY FAMILY CLINIC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 1316 JOSHUA CT SE
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City | BONDURANT
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State | IA
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Zip | 50035-4700
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Country | US
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Telephone | 515-249-5775
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 JOSHUA CT SE
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City | BONDURANT
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State | IA
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Zip | 50035-4700
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Country | US
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Telephone | 515-249-5775
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | LISA SYTSMA
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Credential |
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Telephone | 515-249-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A133377
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License Number State | IA
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