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NPI Code Detail

MEDICARE: WEST FORK FAMILY MEDICINE PC

MEDICARE: WEST FORK FAMILY MEDICINE PC
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
1204D00000XNeuromusculoskeletal Medicine & OMM Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1134351760
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST FORK FAMILY MEDICINE PC
Provider Business Mailing Address
First Line : 705 ELM ST E
Second Line :
City : ROCKWELL
State : IA
Zip : 50469-1035
Country : US
Telephone Number : 641-372-0315
Fax Number :
Provider Business Practice Location Address
First Line : 705 ELM ST E
Second Line :
City : ROCKWELL
State : IA
Zip : 50469-1035
Country : US
Telephone Number : 641-372-0315
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JOSHUA BAKER
Credential : DO
Telephone Number : 641-372-0315
Provider Enumeration Date : 08/15/2009
Last Update Date : 12/16/2009

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Directions to “WEST FORK FAMILY MEDICINE PC ” Practice Location

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