Healthcare Provider Details

I. General information

NPI: 1366986135
Provider Name (Legal Business Name): EASTERN IOWA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 14TH AVE SE
CEDAR RAPIDS IA
52401-2610
US

IV. Provider business mailing address

1201 3RD AVE SE
CEDAR RAPIDS IA
52403-4009
US

V. Phone/Fax

Practice location:
  • Phone: 319-730-7300
  • Fax:
Mailing address:
  • Phone: 319-730-7300
  • Fax: 319-730-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOE LOCK
Title or Position: PRESIDENT & CEO
Credential:
Phone: 319-730-7300