Provider Demographics
NPI:1134351760
Name:WEST FORK FAMILY MEDICINE PC
Entity type:Organization
Organization Name:WEST FORK FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-372-0315
Mailing Address - Street 1:705 ELM ST E
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:IA
Mailing Address - Zip Code:50469-1035
Mailing Address - Country:US
Mailing Address - Phone:641-372-0315
Mailing Address - Fax:
Practice Address - Street 1:705 ELM ST E
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:IA
Practice Address - Zip Code:50469-1035
Practice Address - Country:US
Practice Address - Phone:641-372-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-15
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1522Medicare Oscar/Certification