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General NPI Number Information
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NPI Number | 1902868664
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Entity Type | Organization
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Legal Business Name | CHARITON VALLEY MEDICAL CENTER PC
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 707 S MAIN
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City | CENTERVILLE
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State | IA
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Zip | 52544-2421
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Country | US
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Telephone | 641-437-4344
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Fax | 641-856-5410
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Provider Business Mailing Address
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Address Line | PO BOX 100 707 S MAIN
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City | CENTERVILLE
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State | IA
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Zip | 52544-2421
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Country | US
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Telephone | 641-437-4344
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Fax | 641-856-5410
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN S JEWETT
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Credential | MD
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Telephone | 641-437-4344
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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 | 17554
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License Number State | IA
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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 | 30574
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01603
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License Number State | IA
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