Healthcare Provider Details

I. General information

NPI: 1548269301
Provider Name (Legal Business Name): NEW CENTURY PHYSICIANS OF IOWA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MERCY DR
COUNCIL BLUFFS IA
51503-3128
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 712-328-5230
  • Fax:
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number275930
License Number StateIA

VIII. Authorized Official

Name: MR. STEPHEN G HOLTZCLAW
Title or Position: OWNER
Credential: MD
Phone: 856-686-4316