Provider Demographics
NPI:1952381360
Name:CHARLES CITY FAMILY HEALTH CTR, P.C.
Entity type:Organization
Organization Name:CHARLES CITY FAMILY HEALTH CTR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-228-5151
Mailing Address - Street 1:1501 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3444
Mailing Address - Country:US
Mailing Address - Phone:641-228-5151
Mailing Address - Fax:641-228-2902
Practice Address - Street 1:1501 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3444
Practice Address - Country:US
Practice Address - Phone:641-228-5151
Practice Address - Fax:641-228-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
04260OtherBCBS
04260Medicare ID - Type Unspecified