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General NPI Number Information
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NPI Number | 1568539344
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Entity Type | Organization
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Legal Business Name | THE OTHER MEDICAL CLINIC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 410 E ROBINSON ST B2
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City | KNOXVILLE
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State | IA
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Zip | 50138-2058
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Country | US
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Telephone | 641-842-3700
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Fax | 641-842-3363
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Provider Business Mailing Address
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Address Line | 410 E ROBINSON ST B2
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City | KNOXVILLE
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State | IA
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Zip | 50138-2058
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Country | US
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Telephone | 641-842-3700
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Fax | 641-842-3363
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Authorized Official
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Title or Position | THE OTHER MEDICAL CLINIC PLC EMPLOY
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Name | ALDA L KNIGHT
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Credential | MD FACP
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Telephone | 641-842-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21081
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License Number State | IA
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