MEDICARE: FAMILY HEALTH CENTER OF WATERLOO, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1003013731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CENTER OF WATERLOO, P.C.

Provider Business Mailing Address
First Line	:	220 W RIDGEWAY AVE
Second Line	:	SUITE 106
City	:	WATERLOO
State	:	IA
Zip	:	50701-4200
Country	:	US
Telephone Number	:	319-226-4400
Fax Number	:	319-226-4401

Provider Business Practice Location Address
First Line	:	220 W RIDGEWAY AVE
Second Line	:	SUITE 106
City	:	WATERLOO
State	:	IA
Zip	:	50701-4200
Country	:	US
Telephone Number	:	319-226-4400
Fax Number	:	319-226-4401

Authorized Official
Title or Position	:	OWNER
Name	:	ELLEN L. SAKORNBUT
Credential	:
Telephone Number	:	319-226-4400

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	12/16/2009

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Directions to “FAMILY HEALTH CENTER OF WATERLOO, P.C. ” Practice Location

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