MEDICARE: FAMILY PHYSICIANS OF CEDAR RAPIDS, 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		IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15468	OTHER	IA	CLINIC NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285663849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHYSICIANS OF CEDAR RAPIDS, P.C.

Provider Business Mailing Address
First Line	:	1515 42ND ST NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3061
Country	:	US
Telephone Number	:	319-365-7581
Fax Number	:	319-365-0163

Provider Business Practice Location Address
First Line	:	1515 42ND ST NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3061
Country	:	US
Telephone Number	:	319-365-7581
Fax Number	:	319-365-0163

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK J GOEDKEN
Credential	:	MD
Telephone Number	:	319-365-7581

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/23/2022

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