Provider Demographics
NPI:1902935554
Name:UNDERWOOD FAMILY PRACTICE
Entity Type:Organization
Organization Name:UNDERWOOD FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAROR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:OGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-566-9148
Mailing Address - Street 1:401 HIGHWAY ST
Mailing Address - Street 2:PO BOX 218
Mailing Address - City:UNDERWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51576-0218
Mailing Address - Country:US
Mailing Address - Phone:712-566-9148
Mailing Address - Fax:712-566-9408
Practice Address - Street 1:401 HIGHWAY ST
Practice Address - Street 2:
Practice Address - City:UNDERWOOD
Practice Address - State:IA
Practice Address - Zip Code:51576-0218
Practice Address - Country:US
Practice Address - Phone:712-566-9148
Practice Address - Fax:712-566-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-082459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0732545Medicaid
IADF0999OtherRAILROAD MEDICARE
IA0732545Medicaid
IAS61518Medicare UPIN