Organization
COUNTRY CLINIC MEDICAL SERVICES INC
Active
Other names
Country Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM K COUNTRYMAN D.O. (OWNER)
(515) 987-3117
Entity
Organization
Contact information
Practice address
120 NE DARTMOOR DR, WAUKEE, IA 50263-9660
(515) 987-3117
(515) 987-3119
Mailing address
120 NE DARTMOOR DR, PO BOX 968, WAUKEE, IA 50263-9660
(515) 987-3117
(515) 987-3119
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02312
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0284083
—
IA
05
—
1043646
—
IA
Enumeration date
01/24/2007
Last updated
08/22/2020
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