Provider Demographics
NPI:1508270703
Name:FAMILY FIRST MEDICAL, PLLC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:641-831-3215
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 1:208 E BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:IA
Practice Address - Zip Code:50028-1002
Practice Address - Country:US
Practice Address - Phone:641-227-3045
Practice Address - Fax:641-227-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIN PROCESSOtherBCBS OF IOWA
IAIN PROCESSMedicaid
IAIN PROCESSOtherBCBS OF IOWA