| Mary's Care Memorial Clinic | |
|
210 W 1st St Wall Lake IA 51466-7726 | |
| (712) 790-6033 | |
| Not Available |
| Full Name | Mary's Care Memorial Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 210 W 1st St, Wall Lake, Iowa |
| Authorized Official Name and Position | Karen Phillips (CREDENTIALER) |
| Authorized Official Contact | 7128304728 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary's Care Memorial Clinic Po Box 181 Wall Lake IA 51466-0181 Ph: (712) 790-6033 | Mary's Care Memorial Clinic 210 W 1st St Wall Lake IA 51466-7726 Ph: (712) 790-6033 |
| NPI Number | 1033736871 |
|---|---|
| Provider Enumeration Date | 06/27/2020 |
| Last Update Date | 06/27/2020 |
| Medicare PECOS PAC ID | 0941628887 |
|---|---|
| Medicare Enrollment ID | O20200909002935 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033736871 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Amanda J Buse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417468091 PECOS PAC ID: 4587927405 Enrollment ID: I20180406000398 |
| Provider Name | Allysha Huddleson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508641820 PECOS PAC ID: 1456701796 Enrollment ID: I20231228001151 |