Provider Demographics
NPI:1194737254
Name:REDFIELD MEDICAL CLINIC
Entity type:Organization
Organization Name:REDFIELD MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRIEDMANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:515-833-2301
Mailing Address - Street 1:1013 1ST ST
Mailing Address - Street 2:BOX C
Mailing Address - City:REDFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50233-1007
Mailing Address - Country:US
Mailing Address - Phone:515-833-2301
Mailing Address - Fax:515-833-2108
Practice Address - Street 1:1013 1ST ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:IA
Practice Address - Zip Code:50233-1007
Practice Address - Country:US
Practice Address - Phone:515-833-2301
Practice Address - Fax:515-833-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48917OtherBCBS
IA0638270OtherMEDIPASS
IA1233557Medicaid
IA0638270OtherMEDIPASS