Healthcare Provider Details

I. General information

NPI: 1326448846
Provider Name (Legal Business Name): IOWA MEDICAL & CLASSIFICATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CORAL RIDGE AVE
CORALVILLE IA
52241-4708
US

IV. Provider business mailing address

2700 CORAL RIDGE AVE
CORALVILLE IA
52241-4708
US

V. Phone/Fax

Practice location:
  • Phone: 319-626-4437
  • Fax: 319-665-6721
Mailing address:
  • Phone: 319-626-4437
  • Fax: 319-665-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number18517
License Number StateIA

VIII. Authorized Official

Name: DR. HARBANS DEOL
Title or Position: HEALTH SERVICES ADMINISTRATOR
Credential: DO
Phone: 319-626-4278