Healthcare Provider Details

I. General information

NPI: 1710936604
Provider Name (Legal Business Name): MASON CITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S CRESCENT DR
MASON CITY IA
50401-2926
US

IV. Provider business mailing address

250 S CRESCENT DR
MASON CITY IA
50401-2926
US

V. Phone/Fax

Practice location:
  • Phone: 641-422-6680
  • Fax:
Mailing address:
  • Phone: 641-422-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DANA R YOUNG
Title or Position: ADMINISTRATOR
Credential:
Phone: 641-422-6509