Centerville Medical Clinic

LBN: State University Of Iowa
Centerville Medical Clinic is an health care organization with primary practice located at 19876 St. Joseph Drive , Centerville IA 52544. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. State University Of Iowa can be contacted via phone (641) 856-8684, or through Fisher, Kenneth L via phone (319) 384-2844.

Contact Information

Primary practice address
19876 St. Joseph Drive Centerville IA 52544
Phone: (641) 856-8684
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Fisher, Kenneth L
Phone: (319) 384-2844

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1700835865
LBN Legal business name State University Of Iowa
DBA Doing business as Centerville Medical Clinic
Authorized official Fisher, Kenneth L
Entity Organization
Organization subpart 1 No
Enumeration date May 8th, 2006
Last updated Jul 7th, 2009 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700835865 NPPES
Iowa Other DA0044 RR MEDICARE
Iowa MEDICAID 0280339 RR MEDICARE
Iowa Other 33226 RR MEDICARE

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