1174073597 NPI number — UNITYPOINT CLINIC URGENT CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174073597 NPI number — UNITYPOINT CLINIC URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITYPOINT CLINIC URGENT CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRIMACK PHYSICIANS GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174073597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 KENYON RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FORT DODGE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50501-5740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-574-8484
Provider Business Mailing Address Fax Number:
515-574-8483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 KENYON RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-574-8484
Provider Business Practice Location Address Fax Number:
515-574-8483
Provider Enumeration Date:
10/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RANDALL
Authorized Official First Name:
LISA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
515-574-8488

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  A113462 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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