Provider Demographics
NPI:1154137016
Name:BARILLAS CLINIC LLC
Entity type:Organization
Organization Name:BARILLAS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:O
Authorized Official - Last Name:BARILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:319-594-7755
Mailing Address - Street 1:1524 US HIGHWAY 18 W STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1161
Mailing Address - Country:US
Mailing Address - Phone:641-530-4050
Mailing Address - Fax:641-357-4051
Practice Address - Street 1:1524 US HIGHWAY 18 W
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1161
Practice Address - Country:US
Practice Address - Phone:641-530-4050
Practice Address - Fax:641-357-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care