# MOSAIC MEDICAL CENTER - MARYVILLE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mosaic Family Care - Bedford
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205300498
- **Authorized official:** DWIGHT R CARVELL (DIRECTOR OF REIMBURSEMENT)
- **Authorized official phone:** (816) 273-0473

## Contact information

- **Practice address:** 408 DODGE ST, BEDFORD, IA 50833-1413
- **Practice address phone:** (712) 523-2738
- **Practice address fax:** (712) 523-3256
- **Mailing address:** 408 DODGE ST, BEDFORD, IA 50833-1413
- **Mailing address phone:** (712) 523-2738
- **Mailing address fax:** (712) 523-3256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/22/2019
- **Last updated:** 06/10/2019