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NPI Code Detail

MEDICARE: CHARLES CITY FAMILY HEALTH CTR, P.C.

MEDICARE: CHARLES CITY FAMILY HEALTH CTR, 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104260OTHERBCBS

General Provider Information

NPI Number : 1952381360
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLES CITY FAMILY HEALTH CTR, P.C.
Provider Business Mailing Address
First Line : 1501 S MAIN ST
Second Line : SUITE 1
City : CHARLES CITY
State : IA
Zip : 50616-3444
Country : US
Telephone Number : 641-228-5151
Fax Number : 641-228-2902
Provider Business Practice Location Address
First Line : 1501 S MAIN ST
Second Line : SUITE 1
City : CHARLES CITY
State : IA
Zip : 50616-3444
Country : US
Telephone Number : 641-228-5151
Fax Number : 641-228-2902
Authorized Official
Title or Position : OFFICE MANAGER
Name : VICKIE DEMRO
Credential :
Telephone Number : 641-228-5151
Provider Enumeration Date : 01/20/2006
Last Update Date : 11/20/2017

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Directions to “CHARLES CITY FAMILY HEALTH CTR, P.C. ” Practice Location

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