Organization
WEST BROADWAY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE K LEE PA-C (PHYSICIAN ASSISTANT)
(712) 256-5600
Entity
Organization
Contact information
Practice address
1701 W BROADWAY, COUNCIL BLUFFS, IA 51501-3822
(712) 256-5600
(712) 256-3440
Mailing address
1701 W BROADWAY, COUNCIL BLUFFS, IA 51501-3822
(712) 256-5600
(712) 256-3440
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
076997
IA
Other
Enumeration date
02/10/2015
Last updated
02/16/2015
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