Healthcare Provider Details

I. General information

NPI: 1437209137
Provider Name (Legal Business Name): PHYSICIANS' CLINIC OF IOWA, PC, DEPT OF SURGICAL SPECIALISTS
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

830 4TH AVE SE
CEDAR RAPIDS IA
52403-2423
US

IV. Provider business mailing address

830 4TH AVE SE
CEDAR RAPIDS IA
52403-2423
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-5118
  • Fax: 319-364-0574
Mailing address:
  • Phone: 319-362-5118
  • Fax: 319-364-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier56498
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK GROUP NUMBER

VIII. Authorized Official

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