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1021 11th St De Witt IA 52742-1209 | |
(563) 659-9294 | |
(563) 659-8104 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1021 11th St, De Witt, Iowa |
Authorized Official Name and Position | Joseph D Malas (CFO) |
Authorized Official Contact | 5634216508 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 4028 Rock Island IL 61204-4028 Ph: () - | 1021 11th St De Witt IA 52742-1209 Ph: (563) 659-9294 |
NPI Number | 1124804182 |
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Provider Enumeration Date | 09/06/2023 |
Last Update Date | 12/15/2023 |
Medicare PECOS PAC ID | 7214841436 |
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Medicare Enrollment ID | O20231107003044 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124804182 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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