Provider Demographics
NPI:1073677019
Name:AMANA FAMILY PRACTICE CLINIC, PC
Entity Type:Organization
Organization Name:AMANA FAMILY PRACTICE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOMANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-622-3231
Mailing Address - Street 1:505 39TH AVE
Mailing Address - Street 2:PO BOX 207
Mailing Address - City:AMANA
Mailing Address - State:IA
Mailing Address - Zip Code:52203-8229
Mailing Address - Country:US
Mailing Address - Phone:319-622-3231
Mailing Address - Fax:319-622-3077
Practice Address - Street 1:505 39TH AVE
Practice Address - Street 2:
Practice Address - City:AMANA
Practice Address - State:IA
Practice Address - Zip Code:52203-8229
Practice Address - Country:US
Practice Address - Phone:319-622-3231
Practice Address - Fax:319-622-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACJ8590OtherRAILROAD MEDICARE
IAI7495Medicare PIN
IA0899450001Medicare NSC