Organization
MEDICAL CLINIC LLC
Active
Other names
MEDICAL CLINIC P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIN A HENDRICKSON (CEO)
(712) 382-1515
Entity
Organization
Contact information
Practice address
710 CENTER ST, TABOR, IA 51653-2069
(712) 629-2975
Mailing address
1219 MAIN ST, HAMBURG, IA 51640-1300
(712) 382-2626
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018507
—
IA
05
—
0638361
—
IA
01
—
13034
WELLMARK BC/BS OF IA
IA
Enumeration date
02/08/2006
Last updated
08/12/2024
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