Healthcare Provider Details

I. General information

NPI: 1356390686
Provider Name (Legal Business Name): IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S STORY ST
BOONE IA
50036-4739
US

IV. Provider business mailing address

8101 BIRCHWOOD CT SUITE R
JOHNSTON IA
50131-2930
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-4444
  • Fax: 515-432-1331
Mailing address:
  • Phone: 515-471-9372
  • Fax: 515-471-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ERICK J LAINE
Title or Position: COO
Credential:
Phone: 515-471-9227