Provider Demographics
NPI:1689722175
Name:MOFLE FAMILY CARE CLINIC, P.C.
Entity type:Organization
Organization Name:MOFLE FAMILY CARE CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MOFLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-832-7724
Mailing Address - Street 1:P.O. BOX 631
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595
Mailing Address - Country:US
Mailing Address - Phone:515-606-4561
Mailing Address - Fax:515-606-4946
Practice Address - Street 1:1505 LYNX AVENUE
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595
Practice Address - Country:US
Practice Address - Phone:515-606-4551
Practice Address - Fax:515-606-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5526012Medicaid
IA1710961511OtherNPI PHYSICIAN
G31577Medicare UPIN
IA5526012Medicaid