Organization
FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN FERGUSON (OFFICE MANAGER)
(641) 236-6740
Entity
Organization
Contact information
Practice address
224 3RD AVE, GRINNELL, IA 50112-1817
(641) 236-6740
(641) 236-0013
Mailing address
224 3RD AVE, GRINNELL, IA 50112-1817
(641) 236-6740
(641) 236-0013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0174227
—
IA
01
—
44756
BCBS
IA
Enumeration date
01/29/2007
Last updated
08/22/2020
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