Healthcare Provider Details

I. General information

NPI: 1255769006
Provider Name (Legal Business Name): IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 8TH ST NE
CEDAR RAPIDS IA
52401-1013
US

IV. Provider business mailing address

115 8TH ST NE
CEDAR RAPIDS IA
52401-1013
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-3565
  • Fax:
Mailing address:
  • Phone: 319-363-3565
  • Fax:

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