Provider Demographics
NPI:1568539344
Name:THE OTHER MEDICAL CLINIC
Entity Type:Organization
Organization Name:THE OTHER MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THE OTHER MEDICAL CLINIC PLC EMPLOY
Authorized Official - Prefix:
Authorized Official - First Name:ALDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP
Authorized Official - Phone:641-842-3700
Mailing Address - Street 1:410 E ROBINSON ST
Mailing Address - Street 2:B2
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2058
Mailing Address - Country:US
Mailing Address - Phone:641-842-3700
Mailing Address - Fax:641-842-3363
Practice Address - Street 1:410 E ROBINSON ST
Practice Address - Street 2:B2
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2058
Practice Address - Country:US
Practice Address - Phone:641-842-3700
Practice Address - Fax:641-842-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1871550723OtherDR KNIGHT NPI
IA05986OtherBLUE CROSS
IA6188037Medicaid
IAI16960Medicare ID - Type UnspecifiedMEDICARE GROUP
IA6188037Medicaid