Provider Demographics
NPI:1558139022
Name:MAPLETON MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:MAPLETON MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:YOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:620-743-3049
Mailing Address - Street 1:171 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:KS
Mailing Address - Zip Code:66754-4003
Mailing Address - Country:US
Mailing Address - Phone:620-743-3049
Mailing Address - Fax:
Practice Address - Street 1:171 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:KS
Practice Address - Zip Code:66754-4003
Practice Address - Country:US
Practice Address - Phone:620-743-3049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center