Provider Demographics
NPI:1407845175
Name:MAQUOKETA FAMILY CLINIC
Entity Type:Organization
Organization Name:MAQUOKETA FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-6711
Mailing Address - Street 1:206 N ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2022
Mailing Address - Country:US
Mailing Address - Phone:563-652-6711
Mailing Address - Fax:563-652-6715
Practice Address - Street 1:206 N ARCADE ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2022
Practice Address - Country:US
Practice Address - Phone:563-652-6711
Practice Address - Fax:563-652-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1659360816Medicaid
IA1750370011Medicaid
IA1750370011Medicaid
IA1659360816Medicare NSC
IA1659360816Medicaid
IA1235128596Medicare NSC