Provider Demographics
NPI:1083784771
Name:WEBSTER CITY MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:WEBSTER CITY MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUCHVARA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:515-832-6123
Mailing Address - Street 1:1610 COLLINS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-2623
Mailing Address - Country:US
Mailing Address - Phone:515-832-6123
Mailing Address - Fax:515-832-3397
Practice Address - Street 1:1610 COLLINS ST
Practice Address - Street 2:SUITE A
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2623
Practice Address - Country:US
Practice Address - Phone:515-832-6123
Practice Address - Fax:515-832-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19532207Q00000X
IA1823207R00000X
IA20480208000000X
IA1163363A00000X
IA1334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12830Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER