Provider Demographics
NPI:1598735961
Name:MEDICAL ASSOCIATES OF MAQUOKETA PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF MAQUOKETA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-5145
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:307 E WEBSTER ST
Mailing Address - City:WYOMING
Mailing Address - State:IA
Mailing Address - Zip Code:52362-0058
Mailing Address - Country:US
Mailing Address - Phone:563-488-2297
Mailing Address - Fax:563-488-3313
Practice Address - Street 1:307 E WEBSTER ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:IA
Practice Address - Zip Code:52362
Practice Address - Country:US
Practice Address - Phone:563-488-2297
Practice Address - Fax:563-488-3313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ASSOCIATES OF MAQUOKETA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1126896Medicaid
IA1126896Medicaid