Healthcare Provider Details

I. General information

NPI: 1285784983
Provider Name (Legal Business Name): PHYSICIANS' CLINIC OF IOWA, PC, DEPT OF ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 8TH AVE SE
CEDAR RAPIDS IA
52401-2121
US

IV. Provider business mailing address

901 8TH AVE SE
CEDAR RAPIDS IA
52401-2121
US

V. Phone/Fax

Practice location:
  • Phone: 319-399-2022
  • Fax: 319-399-2014
Mailing address:
  • Phone: 319-399-2022
  • Fax: 319-399-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA S COOPER
Title or Position: CEO
Credential:
Phone: 319-398-1772