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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
1261QR1300XRural Health Clinic/Center

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 : 1295814234
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEER CREEK HEALTH CENTER, LLC
Provider Business Mailing Address
First Line : 401 1ST AVE
Second Line :
City : TOLEDO
State : IA
Zip : 52342-2129
Country : US
Telephone Number : 641-484-2602
Fax Number : 641-484-6837
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 : 641-484-6837
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TERRY J PROTEXTOR
Credential :
Telephone Number : 319-337-7642
Provider Enumeration Date : 11/02/2006
Last Update Date : 02/15/2008

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

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