Basic Information
Provider Information | |||||||||
NPI: | 1124344932 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PATTON FAMILY HEALTH CENTER PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 40 | ||||||||
Address2: | PATTON FAMILY HEALTH CENTER | ||||||||
City: | WEST BRANCH | ||||||||
State: | IA | ||||||||
PostalCode: | 523580040 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3196433462 | ||||||||
FaxNumber: | 3166433467 | ||||||||
Practice Location | |||||||||
Address1: | 116 N 1ST ST | ||||||||
Address2: |   | ||||||||
City: | WEST BRANCH | ||||||||
State: | IA | ||||||||
PostalCode: | 523589663 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3196433462 | ||||||||
FaxNumber: | 3196433467 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2010 | ||||||||
LastUpdateDate: | 05/01/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PATTON | ||||||||
AuthorizedOfficialFirstName: | EMILY | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 3196433462 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | ARNP | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A086807 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.