Healthcare Provider Details

I. General information

NPI: 1558520817
Provider Name (Legal Business Name): WOMENS CARE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S FOURTH ST
CLINTON IA
52732-0000
US

IV. Provider business mailing address

507 S FOURTH ST
CLINTON IA
52732-0000
US

V. Phone/Fax

Practice location:
  • Phone: 563-241-4000
  • Fax: 563-241-4004
Mailing address:
  • Phone: 563-241-4000
  • Fax: 563-241-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number33032
License Number StateIA

VIII. Authorized Official

Name: DR. MONA S ALQULALI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 563-241-4000