Provider Demographics
NPI:1558372409
Name:SOUTHERN IOWA FAMILY PLANNING CLINIC, INC.
Entity Type:Organization
Organization Name:SOUTHERN IOWA FAMILY PLANNING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:641-682-9955
Mailing Address - Street 1:228 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2981
Mailing Address - Country:US
Mailing Address - Phone:641-682-9955
Mailing Address - Fax:641-682-9946
Practice Address - Street 1:228 E 2ND ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2981
Practice Address - Country:US
Practice Address - Phone:641-682-9955
Practice Address - Fax:641-682-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0095232Medicaid