Provider Demographics
NPI:1669425625
Name:CITY FAMILY CLINIC PLC
Entity type:Organization
Organization Name:CITY FAMILY CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CHINWE NKEM
Authorized Official - Last Name:EKWENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-276-8800
Mailing Address - Street 1:6401 DOUGLAS AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3350
Mailing Address - Country:US
Mailing Address - Phone:515-276-8800
Mailing Address - Fax:515-276-8810
Practice Address - Street 1:6401 DOUGLAS AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-3350
Practice Address - Country:US
Practice Address - Phone:515-276-8800
Practice Address - Fax:515-276-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-10-24
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
IA0443960Medicaid
IA0443960Medicaid