Provider Demographics
NPI:1689004368
Name:FAMILY PRACTICE CENTER PHCY
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOEHNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:319-272-2112
Mailing Address - Street 1:2055 KIMBALL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5047
Mailing Address - Country:US
Mailing Address - Phone:319-272-2112
Mailing Address - Fax:319-272-2107
Practice Address - Street 1:2055 KIMBALL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5047
Practice Address - Country:US
Practice Address - Phone:319-272-2112
Practice Address - Fax:319-272-2107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST IOWA MEDICAL EDUCATION FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1482333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy