Healthcare Provider Details

I. General information

NPI: 1124157276
Provider Name (Legal Business Name): PHYSICIANS' CLINIC OF IOWA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/20/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH ST SE STE 290
CEDAR RAPIDS IA
52403-2437
US

IV. Provider business mailing address

PO BOX 3178
CEDAR RAPIDS IA
52406-3178
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-1500
  • Fax: 319-398-1558
Mailing address:
  • Phone: 319-398-1500
  • Fax: 319-398-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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: ERIC DALTON
Title or Position: CFO
Credential:
Phone: 319-247-3049