Organization
SHENANDOAH DOCTORS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY ANTHONY FURSA M.D. (PRESIDENT)
(712) 246-1000
Entity
Organization
Contact information
Practice address
1 JACK FOSTER DR, SUITE #447, SHENANDOAH, IA 51601-4586
(712) 246-1000
(712) 246-1050
Mailing address
1 JACK FOSTER DR, SUITE #447, SHENANDOAH, IA 51601-4586
(712) 246-1000
(712) 246-1050
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
33651
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3214536
—
IA
01
—
35131
MIDLANDS CHOICE
IA
01
—
39007
WELLMARK
IA
01
—
P00232672
RAILROAD MEDICARE
IA
Enumeration date
01/25/2006
Last updated
08/22/2020
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