MEDICARE: PRIMARYCARE HOUSECALLS 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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1861864605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARYCARE HOUSECALLS PC

Provider Business Mailing Address
First Line	:	322 S STATE ST
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-4139
Country	:	US
Telephone Number	:	507-235-9334
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E COURT AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50309-2027
Country	:	US
Telephone Number	:	507-235-9334
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CAROLYN J DREVLOW
Credential	:	NP
Telephone Number	:	507-235-9334

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	10/20/2015

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