Provider Demographics
NPI:1003846098
Name:STUART MEDICAL CLINIC
Entity type:Organization
Organization Name:STUART MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OREWILER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:515-523-2283
Mailing Address - Street 1:106 NE 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:IA
Mailing Address - Zip Code:50250-0196
Mailing Address - Country:US
Mailing Address - Phone:515-523-2283
Mailing Address - Fax:515-523-2786
Practice Address - Street 1:106 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:IA
Practice Address - Zip Code:50250-7706
Practice Address - Country:US
Practice Address - Phone:515-523-2283
Practice Address - Fax:515-523-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000971363A00000X
IA28764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA168943Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC
IAIB1169Medicare UPIN
IA59220Medicare ID - Type UnspecifiedGROUP