Provider Demographics
NPI:1861864605
Name:PRIMARYCARE HOUSECALLS PC
Entity type:Organization
Organization Name:PRIMARYCARE HOUSECALLS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DREVLOW
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:507-235-9334
Mailing Address - Street 1:322 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4139
Mailing Address - Country:US
Mailing Address - Phone:507-235-9334
Mailing Address - Fax:
Practice Address - Street 1:400 E COURT AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2027
Practice Address - Country:US
Practice Address - Phone:507-235-9334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care