Provider Demographics
NPI:1972671493
Name:FAMILY MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:AULWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-252-2141
Mailing Address - Street 1:101 SOUTH WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:52042
Mailing Address - Country:US
Mailing Address - Phone:563-928-6435
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:IA
Practice Address - Zip Code:52042
Practice Address - Country:US
Practice Address - Phone:563-928-6435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0689117Medicaid
IA14482OtherBILLING NUMBER
IA14482Medicare ID - Type UnspecifiedBILLING NUMBER
IA0689117Medicaid