Healthcare Provider Details

I. General information

NPI: 1285849596
Provider Name (Legal Business Name): KIRKWOOD COMMUNITY COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 KIRKWOOD BLVD SW
CEDAR RAPIDS IA
52404-5260
US

IV. Provider business mailing address

6301 KIRKWOOD BLVD SW
CEDAR RAPIDS IA
52404-5260
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-5559
  • Fax: 319-398-7619
Mailing address:
  • Phone: 319-398-5559
  • Fax: 319-398-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0150649
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MS. ELIZABETH SELK
Title or Position: DIRECTOR
Credential:
Phone: 319-398-5559