Mary's Care Memorial Clinic | |
210 W 1st St Wall Lake IA 51466-7726 | |
(712) 790-6033 | |
Not Available |
Full Name | Mary's Care Memorial Clinic |
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Speciality | Clinic/Center |
Location | 210 W 1st St, Wall Lake, Iowa |
Authorized Official Name and Position | Karen Phillips (CREDENTIALER) |
Authorized Official Contact | 7128304728 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mary's Care Memorial Clinic Po Box 181 Wall Lake IA 51466-0181 Ph: (712) 790-6033 | Mary's Care Memorial Clinic 210 W 1st St Wall Lake IA 51466-7726 Ph: (712) 790-6033 |
NPI Number | 1033736871 |
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Provider Enumeration Date | 06/27/2020 |
Last Update Date | 06/27/2020 |
Medicare PECOS PAC ID | 0941628887 |
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Medicare Enrollment ID | O20200909002935 |
Identifier | Type | State | Issuer |
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1033736871 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Amanda J Buse |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417468091 PECOS PAC ID: 4587927405 Enrollment ID: I20180406000398 |
Provider Name | Allysha Huddleson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508641820 PECOS PAC ID: 1456701796 Enrollment ID: I20231228001151 |