Healthcare Provider Details

I. General information

NPI: 1730115213
Provider Name (Legal Business Name): NEWTON CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 4TH AVE E SUITE 200
NEWTON IA
50208-3155
US

IV. Provider business mailing address

300 N 4TH AVE E SUITE 200
NEWTON IA
50208-3155
US

V. Phone/Fax

Practice location:
  • Phone: 641-792-2112
  • Fax: 641-792-8484
Mailing address:
  • Phone: 641-792-2112
  • Fax: 641-792-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK THAYER
Title or Position: CLINIC ADMINSTRATOR
Credential:
Phone: 641-792-2112