| Countryside Medical Clinic, Llc | |
|
1959 200th St Red Oak IA 51566-3218 | |
| (712) 629-0040 | |
| (712) 566-5049 |
| Full Name | Countryside Medical Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1959 200th St, Red Oak, Iowa |
| Authorized Official Name and Position | Kimberly Lynn Rines (NURSE PRACTITIONER) |
| Authorized Official Contact | 7126290040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Countryside Medical Clinic, Llc 1959 200th St Red Oak IA 51566-3218 Ph: (712) 629-0040 | Countryside Medical Clinic, Llc 1959 200th St Red Oak IA 51566-3218 Ph: (712) 629-0040 |
| NPI Number | 1396103685 |
|---|---|
| Provider Enumeration Date | 02/02/2016 |
| Last Update Date | 12/12/2018 |
| Medicare PECOS PAC ID | 5890090294 |
|---|---|
| Medicare Enrollment ID | O20160223001653 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396103685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kimberly Lynn Rines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932455052 PECOS PAC ID: 1557512456 Enrollment ID: I20121126000521 |
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