Provider Demographics
NPI:1235173378
Name:DR. EISCHEN CLINIC, P. C.
Entity Type:Organization
Organization Name:DR. EISCHEN CLINIC, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GERHARDT
Authorized Official - Last Name:EISCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-396-2989
Mailing Address - Street 1:106 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IA
Mailing Address - Zip Code:50240-0267
Mailing Address - Country:US
Mailing Address - Phone:641-396-2989
Mailing Address - Fax:
Practice Address - Street 1:106 WEST MAIN STREET
Practice Address - Street 2:SUITE 267
Practice Address - City:SAINT CHARLES
Practice Address - State:IA
Practice Address - Zip Code:50240-0267
Practice Address - Country:US
Practice Address - Phone:641-396-2989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty