Healthcare Provider Details

I. General information

NPI: 1588922819
Provider Name (Legal Business Name): IOWA URGENT CARE PROVIDER NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7332 E BUTHERUS DR HANGAR ONE
SCOTTSDALE AZ
85260-2426
US

IV. Provider business mailing address

7332 E BUTHERUS DR HANGAR ONE
SCOTTSDALE AZ
85260-2426
US

V. Phone/Fax

Practice location:
  • Phone: 813-777-6453
  • Fax:
Mailing address:
  • Phone: 813-777-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberW00780584
License Number StateIA

VIII. Authorized Official

Name: LOU ELLEN HORWITZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 813-777-6453