Organization
FAMILY & SPECIALTY MEDICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANETTE M FOX (CREDENTIALING)
(712) 792-4000
Entity
Organization
Contact information
Practice address
515 N MAIN ST, CARROLL, IA 51401-2739
(712) 792-4000
(712) 792-7773
Mailing address
515 N MAIN ST, CARROLL, IA 51401-2739
(712) 792-4000
(712) 792-7773
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207Q00000X
Family Medicine Physician
Primary
3267
IA
225100000X
Physical Therapist
02754
IA
363AM0700X
Medical Physician Assistant
000745
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH4508
RAILROAD MEDICARE GROUP #
IA
Enumeration date
07/22/2006
Last updated
10/09/2014
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