Provider Demographics
NPI: | 1841244431 |
---|---|
Name: | MEDICAL ASSOCIATES OF CLINTON, IOWA P.L.C. |
Entity Type: | Organization |
Organization Name: | MEDICAL ASSOCIATES OF CLINTON, IOWA P.L.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF ADMINISTRATIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAY |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | COLLIER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 563-243-2511 |
Mailing Address - Street 1: | 915 13TH AVE N |
Mailing Address - Street 2: | |
Mailing Address - City: | CLINTON |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52732-5067 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 563-243-2511 |
Mailing Address - Fax: | 563-243-0817 |
Practice Address - Street 1: | 915 13TH AVE N |
Practice Address - Street 2: | |
Practice Address - City: | CLINTON |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52732-5067 |
Practice Address - Country: | US |
Practice Address - Phone: | 563-243-2511 |
Practice Address - Fax: | 563-243-0817 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-19 |
Last Update Date: | 2017-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 09822109 | Other | BC/BS ILLINOIS |
IL | 09822166 | Other | BC/BS ILLINOIS |
IL | CG9166 | Other | RAILROAD MEDICARE |
IA | 0088823 | Medicaid | |
IA | 20301 | Other | WELLMARK BC/BS |
IL | 0561370001 | Medicare NSC | |
IA | 20301 | Medicare PIN | |
IL | 09822166 | Other | BC/BS ILLINOIS |
IA | 20301 | Other | WELLMARK BC/BS |
IL | 09822109 | Other | BC/BS ILLINOIS |