Provider Demographics
NPI:1730115213
Name:NEWTON CLINIC PC
Entity Type:Organization
Organization Name:NEWTON CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-792-2112
Mailing Address - Street 1:300 N 4TH AVE E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3155
Mailing Address - Country:US
Mailing Address - Phone:641-792-2112
Mailing Address - Fax:641-792-8484
Practice Address - Street 1:300 N 4TH AVE E
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3155
Practice Address - Country:US
Practice Address - Phone:641-792-2112
Practice Address - Fax:641-792-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0282186Medicaid
IA71982Medicare PIN
IA0282186Medicaid