| |
925 South 4th Street Clinton IA 52732-5726 | |
(563) 336-3000 | |
(563) 336-3125 |
Full Name | |
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Speciality | Clinic/Center |
Location | 925 South 4th Street, Clinton, Iowa |
Authorized Official Name and Position | Thomas Bowman (CEO) |
Authorized Official Contact | 5633363000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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500 W River Dr Davenport IA 52801-1014 Ph: (563) 336-3000 | 925 South 4th Street Clinton IA 52732-5726 Ph: (563) 336-3000 |
NPI Number | 1598152019 |
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Provider Enumeration Date | 04/22/2015 |
Last Update Date | 08/05/2015 |
Medicare PECOS PAC ID | 9830008895 |
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Medicare Enrollment ID | O20150807013771 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598152019 | NPI | - | NPPES |
PENDING | Medicaid | IL | |
PENDING | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Iowa) | Primary |
Randy R Robinson Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2027 S 21st St, Clinton, IA 52732 Phone: 563-243-7200 Fax: 563-243-7201 | |
Betty A Hibler Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1320 Main Ave, Clinton, IA 52732 Phone: 563-243-3752 | |
Michael Mankarious Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 638 S Bluff Blvd, Clinton, IA 52732 Phone: 563-243-5601 Fax: 563-243-5637 | |