Provider Demographics
NPI:1639250293
Name:CHARLES F EDDINGFIELD MD
Entity Type:Organization
Organization Name:CHARLES F EDDINGFIELD MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:EDDINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-524-7777
Mailing Address - Street 1:1610 MORGAN STREET
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632
Mailing Address - Country:US
Mailing Address - Phone:319-524-7777
Mailing Address - Fax:319-524-7782
Practice Address - Street 1:1610 MORGAN STREET
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632
Practice Address - Country:US
Practice Address - Phone:319-524-7777
Practice Address - Fax:319-524-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18836208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0089458Medicaid
A00992Medicare UPIN
08945Medicare ID - Type Unspecified