Healthcare Provider Details

I. General information

NPI: 1013952183
Provider Name (Legal Business Name): IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E J AVE STE 120
GRUNDY CENTER IA
50638-2006
US

IV. Provider business mailing address

8101 BIRCHWOOD COURT SUITE R
JOHNSTON IA
50131-2930
US

V. Phone/Fax

Practice location:
  • Phone: 319-824-6945
  • Fax: 319-824-6947
Mailing address:
  • Phone: 515-471-9243
  • 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: ERICK J LAINE
Title or Position: COO
Credential:
Phone: 515-471-9227