Healthcare Provider Details

I. General information

NPI: 1558412601
Provider Name (Legal Business Name): PHYSICIANS' CLINIC OF IOWA, PC, DEPT OF NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 7TH ST SE
CEDAR RAPIDS IA
52401-2112
US

IV. Provider business mailing address

600 7TH ST SE
CEDAR RAPIDS IA
52401-2112
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-1721
  • Fax: 319-399-2016
Mailing address:
  • Phone: 319-398-1721
  • Fax: 319-399-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier13448
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK GROUP NUMBER

VIII. Authorized Official

Name: DONNA S COOPER
Title or Position: CEO
Credential:
Phone: 318-398-1772