Provider Demographics
NPI:1467411611
Name:DUBUQUE FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:DUBUQUE FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-583-9300
Mailing Address - Street 1:320 N GRANDVIEW AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6328
Mailing Address - Country:US
Mailing Address - Phone:563-583-9300
Mailing Address - Fax:563-589-2555
Practice Address - Street 1:320 N GRANDVIEW AVE
Practice Address - Street 2:SUITE D
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6328
Practice Address - Country:US
Practice Address - Phone:563-583-9300
Practice Address - Fax:563-589-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0078576Medicaid
IA04536Medicare UPIN
IA04536Medicare ID - Type Unspecified