Provider Demographics
NPI:1033736871
Name:MARY'S CARE MEMORIAL CLINIC
Entity Type:Organization
Organization Name:MARY'S CARE MEMORIAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-830-4728
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:WALL LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51466-0181
Mailing Address - Country:US
Mailing Address - Phone:712-790-6033
Mailing Address - Fax:
Practice Address - Street 1:210 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WALL LAKE
Practice Address - State:IA
Practice Address - Zip Code:51466-7726
Practice Address - Country:US
Practice Address - Phone:712-790-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care