Provider Demographics
NPI:1477505915
Name:SHELL ROCK FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:SHELL ROCK FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKIERKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-885-6530
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2400
Mailing Address - Country:US
Mailing Address - Phone:319-233-3044
Mailing Address - Fax:319-233-0722
Practice Address - Street 1:513 NORTH CHERRY ST
Practice Address - Street 2:
Practice Address - City:SHELL ROCK
Practice Address - State:IA
Practice Address - Zip Code:50670
Practice Address - Country:US
Practice Address - Phone:319-885-6530
Practice Address - Fax:319-885-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10315OtherBLUE SHIELD
IA10315OtherBLUE SHIELD
IAI17454Medicare ID - Type Unspecified