Provider Demographics
NPI:1316600737
Name:ULTIMATE CARE MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:ULTIMATE CARE MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JANNICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, FNP- C
Authorized Official - Phone:641-223-8365
Mailing Address - Street 1:127 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1248
Mailing Address - Country:US
Mailing Address - Phone:641-223-8365
Mailing Address - Fax:641-223-8364
Practice Address - Street 1:127 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1248
Practice Address - Country:US
Practice Address - Phone:641-223-8365
Practice Address - Fax:641-223-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health