Provider Demographics
NPI:1154572600
Name:SOUTHEAST IOWA FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:SOUTHEAST IOWA FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, FNP-C
Authorized Official - Phone:319-646-2800
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:WELLMAN
Mailing Address - State:IA
Mailing Address - Zip Code:52356-0473
Mailing Address - Country:US
Mailing Address - Phone:319-646-2800
Mailing Address - Fax:319-646-2600
Practice Address - Street 1:217 8TH AVE SUITE 3
Practice Address - Street 2:
Practice Address - City:WELLMAN
Practice Address - State:IA
Practice Address - Zip Code:52356-0473
Practice Address - Country:US
Practice Address - Phone:319-646-2800
Practice Address - Fax:319-646-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center