Provider Demographics
NPI:1003910100
Name:ST CHARLES MEDICAL CLINIC PLC
Entity Type:Organization
Organization Name:ST CHARLES MEDICAL CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-238-9541
Mailing Address - Street 1:903 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-1421
Mailing Address - Country:US
Mailing Address - Phone:515-418-2883
Mailing Address - Fax:
Practice Address - Street 1:101 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IA
Practice Address - Zip Code:50240-1522
Practice Address - Country:US
Practice Address - Phone:515-418-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty