Basic Information
| Provider Information | |||||||||
| NPI: | 1508270703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY FIRST MEDICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 GRAND AVE | ||||||||
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| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503125305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152373974 | ||||||||
| FaxNumber: | 5158832692 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 E BUCHANAN ST | ||||||||
| Address2: | |||||||||
| City: | BAXTER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500281002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6412273045 | ||||||||
| FaxNumber: | 6412273046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2014 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | PEARSON | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6418313215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 098752 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | IN PROCESS | 01 | IA | BCBS OF IOWA | OTHER | IN PROCESS | 05 | IA | MEDICAID |