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NPI Code Detail

MEDICARE: DEER CREEK HEALTH CENTER, LLC

MEDICARE: DEER CREEK HEALTH CENTER, LLC
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
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CI7793OTHERIARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134177629
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEER CREEK HEALTH CENTER, LLC
Provider Business Mailing Address
First Line : 2941 SIERRA CT SW
Second Line :
City : IOWA CITY
State : IA
Zip : 52240-8503
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 401 1ST AVE
Second Line :
City : TOLEDO
State : IA
Zip : 52342-2129
Country : US
Telephone Number : 641-484-2602
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TERRY PROTEXTOR
Credential :
Telephone Number : 319-337-7642
Provider Enumeration Date : 05/05/2006
Last Update Date : 02/15/2008

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Directions to “DEER CREEK HEALTH CENTER, LLC ” Practice Location

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