Provider Demographics
NPI:1679557870
Name:CHEROKEE FAMILY PRACTICE, INC
Entity type:Organization
Organization Name:CHEROKEE FAMILY PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:712-225-0191
Mailing Address - Street 1:213 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1833
Mailing Address - Country:US
Mailing Address - Phone:712-225-0191
Mailing Address - Fax:712-225-0196
Practice Address - Street 1:213 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1833
Practice Address - Country:US
Practice Address - Phone:712-225-0191
Practice Address - Fax:712-225-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291328Medicaid
IA46883Medicare PIN
IA0291328Medicaid