MEDICARE: FAMILY PRACTICE CLINIC PLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	DE5916	OTHER		PALMETTO GBA RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5656790001	OTHER	IA	DMERC REGION D
2	IA0100	OTHER		HERITAGE
3	07022	OTHER	IA	WELLMARK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	07022	OTHER	IA	BLUE SHIELD
6	124831	OTHER		HEALTH PARTNERS

General Provider Information

NPI Number	:	1114912813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE CLINIC PLC

Provider Business Mailing Address
First Line	:	125 SCHOOL ST
Second Line	:	PO BOX F
City	:	CARLISLE
State	:	IA
Zip	:	50047-0705
Country	:	US
Telephone Number	:	515-989-3221
Fax Number	:	515-989-4518

Provider Business Practice Location Address
First Line	:	125 SCHOOL ST
Second Line	:
City	:	CARLISLE
State	:	IA
Zip	:	50047-8702
Country	:	US
Telephone Number	:	515-989-3221
Fax Number	:	515-989-4518

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	DR. MICHAEL J MCCORMICK
Credential	:	DO
Telephone Number	:	515-989-3221

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/31/2008

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Directions to “FAMILY PRACTICE CLINIC PLC ” Practice Location

Language	Start Address	Practice Location

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