Healthcare Provider Details

I. General information

NPI: 1407304892
Provider Name (Legal Business Name): IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENYON RD STE S
FORT DODGE IA
50501-5776
US

IV. Provider business mailing address

PO BOX 1455
DES MOINES IA
50306-1455
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6800
  • Fax: 515-573-7234
Mailing address:
  • Phone: 515-471-9300
  • Fax: 515-471-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID WILLIAMS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 515-471-9200