Healthcare Provider Details

I. General information

NPI: 1588703060
Provider Name (Legal Business Name): CLINIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 1ST AVE W
NEWTON IA
50208-3001
US

IV. Provider business mailing address

400 1ST AVE W
NEWTON IA
50208-3001
US

V. Phone/Fax

Practice location:
  • Phone: 641-792-3528
  • Fax: 641-792-3526
Mailing address:
  • Phone: 641-792-3528
  • Fax: 641-792-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number1187
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1621350
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerNABP #

VIII. Authorized Official

Name: JULIE A MCCAREY
Title or Position: OWNER
Credential: RPH
Phone: 641-792-3528