Provider Demographics
NPI:1801825518
Name:THOMAS G. MCMULLAN
Entity Type:Organization
Organization Name:THOMAS G. MCMULLAN
Other - Org Name:POSTVILLE CLINIC AKA POSTVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MCMULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-864-7221
Mailing Address - Street 1:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:POSTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52162-0799
Mailing Address - Country:US
Mailing Address - Phone:563-864-7221
Mailing Address - Fax:563-864-7224
Practice Address - Street 1:124 WEST GREENE STREET
Practice Address - Street 2:
Practice Address - City:POSTVILLE
Practice Address - State:IA
Practice Address - Zip Code:52162
Practice Address - Country:US
Practice Address - Phone:563-864-7221
Practice Address - Fax:563-864-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24858207R00000X
IA23234208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16635Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER