Provider Demographics
NPI:1104895044
Name:DECATUR MEDICAL SERVICES, PC
Entity type:Organization
Organization Name:DECATUR MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:EASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-784-3371
Mailing Address - Street 1:802 ACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:LAMONI
Mailing Address - State:IA
Mailing Address - Zip Code:50140-1544
Mailing Address - Country:US
Mailing Address - Phone:641-784-3371
Mailing Address - Fax:641-784-6162
Practice Address - Street 1:802 ACKERLY ST
Practice Address - Street 2:
Practice Address - City:LAMONI
Practice Address - State:IA
Practice Address - Zip Code:50140-1544
Practice Address - Country:US
Practice Address - Phone:641-784-3371
Practice Address - Fax:641-784-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0200261Medicaid
IA0200261Medicaid