Provider Demographics
NPI:1346356466
Name:CLINTON URGENT CARE PLC
Entity Type:Organization
Organization Name:CLINTON URGENT CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ODUAH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:OSARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-241-1239
Mailing Address - Street 1:108 S. 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4425
Mailing Address - Country:US
Mailing Address - Phone:563-241-1239
Mailing Address - Fax:563-241-1243
Practice Address - Street 1:108 S. 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4425
Practice Address - Country:US
Practice Address - Phone:563-241-1239
Practice Address - Fax:563-241-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WI0500X, 202C00000X, 207Q00000X, 207QA0401X, 261QU0200X
IA31351202C00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1346356466OtherNPI
IA0724542Medicaid
IA16D0969125OtherCLIA
IA123860251OtherDUNS
IA235597OtherCORP#
IA16D0969125OtherCLIA
IA1346356466OtherNPI