Full Name | |
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Speciality | Clinic/Center |
Location | 908 Main St, Malvern, Iowa |
Authorized Official Name and Position | Ronald G Kloewer (ADMINISTRATOR/CEO) |
Authorized Official Contact | 7126237000 |
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 498 Red Oak IA 51566-0498 Ph: (712) 623-7000 | 908 Main St Malvern IA 51551-8147 Ph: (712) 624-6010 |
NPI Number | 1639768401 |
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Provider Enumeration Date | 01/15/2021 |
Last Update Date | 12/06/2022 |
Medicare PECOS PAC ID | 9032015805 |
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Medicare Enrollment ID | O20210120001334 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639768401 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |