| Jch Professional Clinic | |
|
2000 S Main St Fairfield IA 52556-9572 | |
| (641) 469-4204 | |
| (641) 469-4208 |
| Full Name | Jch Professional Clinic |
|---|---|
| Speciality | Surgery |
| Location | 2000 S Main St, Fairfield, Iowa |
| Authorized Official Name and Position | Larry Dale Peach (CFO) |
| Authorized Official Contact | 6414694304 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jch Professional Clinic 2000 S Main St Fairfield IA 52556-9572 Ph: (641) 469-4204 | Jch Professional Clinic 2000 S Main St Fairfield IA 52556-9572 Ph: (641) 469-4204 |
| NPI Number | 1972771384 |
|---|---|
| Provider Enumeration Date | 02/19/2008 |
| Last Update Date | 02/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972771384 | NPI | - | NPPES |
| 0468850 | Medicaid | IA | |
| 33819 | Other | IA | WELLMARK BC/BS OF IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 37410 (Iowa) | Secondary |
| 208600000X | Surgery | 22423 (Iowa) | Primary |
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› Verified 6 days ago
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