Provider Demographics
NPI:1942516471
Name:RED HAW FAMILY MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:RED HAW FAMILY MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE/OBGYN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DEWAIN
Authorized Official - Last Name:SUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-217-9115
Mailing Address - Street 1:1030 N 7TH ST
Mailing Address - Street 2:PO BOX 674
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1206
Mailing Address - Country:US
Mailing Address - Phone:641-217-9115
Mailing Address - Fax:641-217-9137
Practice Address - Street 1:1030 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1206
Practice Address - Country:US
Practice Address - Phone:641-217-9115
Practice Address - Fax:641-217-9137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-21
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37367207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0103836Medicaid
IA0103836Medicaid