Provider Demographics
NPI:1295715597
Name:MEDICAL ASSOCIATES OF MAQUOKETA, P.C.
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF MAQUOKETA, P.C.
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 1:918 W PLATT ST # 1
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2038
Mailing Address - Country:US
Mailing Address - Phone:563-652-5145
Mailing Address - Fax:563-652-3674
Practice Address - Street 1:918 W PLATT ST # 1
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2038
Practice Address - Country:US
Practice Address - Phone:563-652-5145
Practice Address - Fax:563-652-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0126896Medicaid
IACP8149OtherRAILROAD MEDICARE
IA1126896Medicaid
27039Medicare PIN
12689Medicare PIN