MEDICARE: DR. EISCHEN CLINIC, 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	02094	IA

General Provider Information

NPI Number	:	1235173378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. EISCHEN CLINIC, P. C.

Provider Business Mailing Address
First Line	:	106 WEST MAIN STREET
Second Line	:
City	:	SAINT CHARLES
State	:	IA
Zip	:	50240-0267
Country	:	US
Telephone Number	:	641-396-2989
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 WEST MAIN STREET
Second Line	:	SUITE 267
City	:	SAINT CHARLES
State	:	IA
Zip	:	50240-0267
Country	:	US
Telephone Number	:	641-396-2989
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. WILLIAM GERHARDT EISCHEN
Credential	:	D.O.
Telephone Number	:	641-396-2989

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/22/2020

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