Provider Demographics
NPI:1114912813
Name:FAMILY PRACTICE CLINIC PLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-989-3221
Mailing Address - Street 1:125 SCHOOL ST
Mailing Address - Street 2:PO BOX F
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-0705
Mailing Address - Country:US
Mailing Address - Phone:515-989-3221
Mailing Address - Fax:515-989-4518
Practice Address - Street 1:125 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-8702
Practice Address - Country:US
Practice Address - Phone:515-989-3221
Practice Address - Fax:515-989-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5656790001OtherDMERC REGION D
IA0100OtherHERITAGE
IA07022OtherWELLMARK
IA0479345Medicaid
IA07022OtherBLUE SHIELD
124831OtherHEALTH PARTNERS
DE5916OtherPALMETTO GBA RR MEDICARE
=========OtherUHC
IA0479345Medicaid
IA5656790001OtherDMERC REGION D
IA07022OtherBLUE SHIELD
124831OtherHEALTH PARTNERS
IA0100OtherHERITAGE
IA5656790001OtherDMERC REGION D