Provider Demographics
NPI:1235118118
Name:DAVENPORT CLINIC, P.C.
Entity Type:Organization
Organization Name:DAVENPORT CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-326-1661
Mailing Address - Street 1:1820 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52802-1812
Mailing Address - Country:US
Mailing Address - Phone:563-326-1661
Mailing Address - Fax:563-326-1901
Practice Address - Street 1:1820 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1812
Practice Address - Country:US
Practice Address - Phone:563-326-1661
Practice Address - Fax:563-326-1901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVENPORT CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-10
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care