Mary's Care Memorial Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MARY'S CARE MEMORIAL CLINIC

Practice address

210 W 1St St
Wall Lake, IA 51466-7726

Phone

(712) 790-6033

NPI assigned

Jun 27, 2020

Last updated

Jun 27, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karen Phillips

Title

Credentialer

Phone

(712) 830-4728

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593216000000",
    "number": "1033736871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 181",
            "city": "WALL LAKE",
            "state": "IA",
            "postal_code": "514660181",
            "telephone_number": "712-790-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 1ST ST",
            "city": "WALL LAKE",
            "state": "IA",
            "postal_code": "514667726",
            "telephone_number": "712-790-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY'S CARE MEMORIAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-27",
        "last_updated": "2020-06-27",
        "certification_date": "2020-06-27",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CREDENTIALER",
        "authorized_official_telephone_number": "712-830-4728"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Wall Lake, IA
• Providers in Wall Lake, IA by specialty
• Primary Care Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.