Provider Demographics
NPI:1467042895
Name:MAUCK MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:MAUCK MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:785-657-1434
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-0703
Mailing Address - Country:US
Mailing Address - Phone:785-657-1434
Mailing Address - Fax:
Practice Address - Street 1:917 PINE AVE STE D
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-4216
Practice Address - Country:US
Practice Address - Phone:785-677-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care