Provider Demographics
NPI:1235183419
Name:MANSON FAMILY HEALTH INC
Entity Type:Organization
Organization Name:MANSON FAMILY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:712-469-3307
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1303 11TH AVE
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563-5065
Practice Address - Country:US
Practice Address - Phone:712-469-3307
Practice Address - Fax:712-469-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA168947OtherMEDICARE RURAL HEALTH PIN
IA0425082Medicaid
IADD8904OtherRAILROAD MEDICARE PIN
IA168947Medicare Oscar/Certification
IAS36797Medicare UPIN