Provider Demographics
NPI:1861406787
Name:DELAWARE FAMILY MEDICINE, PLC
Entity type:Organization
Organization Name:DELAWARE FAMILY MEDICINE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-964-5555
Mailing Address - Street 1:1605 SE DELAWARE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4594
Mailing Address - Country:US
Mailing Address - Phone:515-964-5555
Mailing Address - Fax:
Practice Address - Street 1:1605 SE DELAWARE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4594
Practice Address - Country:US
Practice Address - Phone:515-964-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0227850Medicaid
IA0227850Medicaid