Provider Demographics
NPI:1215345905
Name:FAMILY MEDICINE AND MORE, PLC
Entity type:Organization
Organization Name:FAMILY MEDICINE AND MORE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUNNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:319-826-6773
Mailing Address - Street 1:1350 BOYSON RD
Mailing Address - Street 2:BLDG C
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2211
Mailing Address - Country:US
Mailing Address - Phone:319-826-6773
Mailing Address - Fax:319-826-6775
Practice Address - Street 1:1350 BOYSON RD
Practice Address - Street 2:BLDG C
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2211
Practice Address - Country:US
Practice Address - Phone:319-826-6773
Practice Address - Fax:319-826-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37419261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215345905Medicaid
IADW1549OtherRR MEDICARE PROVIDER NUMBER
IAIB3224Medicare PIN