Provider Demographics
NPI:1740258375
Name:GUTHRIE FAMILY MEDICINE CENTER PLC
Entity type:Organization
Organization Name:GUTHRIE FAMILY MEDICINE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASCOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-332-2365
Mailing Address - Street 1:502 MAIN
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115
Mailing Address - Country:US
Mailing Address - Phone:641-332-2365
Mailing Address - Fax:641-332-2370
Practice Address - Street 1:502 MAIN
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115
Practice Address - Country:US
Practice Address - Phone:641-332-2365
Practice Address - Fax:641-332-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080023738OtherRR MEDICARE
IA0105OtherJOHN DEERE
080023739OtherRAIL ROAD MEDICARE
IA0293423Medicaid
183053OtherFIRST ADMINISTRATORS
IA0179945Medicaid
IA0183053Medicaid
22362OtherIOWA LICENCE NUMBER
241160OtherMIDLANDS
IA0106OtherJOHN DEERE
10821OtherMIDLANDS
179945OtherFIRST ADMINISTRATORS
22458OtherIOWA LICENCE NUMBER
17994OtherBLUE CROSS BLUE SHIELD
18305OtherBLUE CROSS BLUE SHIELD
IA18305Medicare ID - Type UnspecifiedDAVID R ATHRENS MD
IA0293423Medicaid
IA0106OtherJOHN DEERE
179945OtherFIRST ADMINISTRATORS
IA0179945Medicaid