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5616 460th St Paullina IA 51046-7516 | |
(712) 448-2000 | |
(712) 448-2004 |
Full Name | |
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Speciality | Clinic/Center |
Location | 5616 460th St, Paullina, Iowa |
Authorized Official Name and Position | Martin W Guthmiller (CEO) |
Authorized Official Contact | 7127375274 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5616 460th St Po Box 360 Paullina IA 51046-7516 Ph: (712) 448-2000 | 5616 460th St Paullina IA 51046-7516 Ph: (712) 448-2000 |
NPI Number | 1518932821 |
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Provider Enumeration Date | 02/21/2006 |
Last Update Date | 02/09/2023 |
Medicare PECOS PAC ID | 4688587231 |
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Medicare Enrollment ID | O20100205000707 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518932821 | NPI | - | NPPES |
0634626 | Medicaid | IA | |
63462 | Other | IA | BLUE CROSS/BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |