Provider Demographics
NPI:1467638072
Name:CRAIN MEDICAL CLINIC
Entity Type:Organization
Organization Name:CRAIN MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-464-3911
Mailing Address - Street 1:207 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854-1635
Mailing Address - Country:US
Mailing Address - Phone:641-464-3911
Mailing Address - Fax:
Practice Address - Street 1:207 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-1635
Practice Address - Country:US
Practice Address - Phone:641-464-3911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291450Medicaid
IA0291450Medicaid