MEDICARE: MOSAIC MEDICAL CENTER - MARYVILLE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	208000000X	Pediatrics Physician
4	363LF0000X	Family Nurse Practitioner
5	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1205300498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAIC MEDICAL CENTER - MARYVILLE

Provider Business Mailing Address
First Line	:	408 DODGE ST
Second Line	:
City	:	BEDFORD
State	:	IA
Zip	:	50833-1413
Country	:	US
Telephone Number	:	712-523-2738
Fax Number	:	712-523-3256

Provider Business Practice Location Address
First Line	:	408 DODGE ST
Second Line	:
City	:	BEDFORD
State	:	IA
Zip	:	50833-1413
Country	:	US
Telephone Number	:	712-523-2738
Fax Number	:	712-523-3256

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	DWIGHT R CARVELL
Credential	:
Telephone Number	:	816-273-0473

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	06/10/2019

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Directions to “MOSAIC MEDICAL CENTER - MARYVILLE ” Practice Location

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