Healthcare Provider Details

I. General information

NPI: 1164976437
Provider Name (Legal Business Name): IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENYON RD SUITE P
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: 515-574-6079
  • Fax: 515-574-4855
Mailing address:
  • Phone: 515-471-9300
  • Fax: 515-471-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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