Healthcare Provider Details

I. General information

NPI: 1174130132
Provider Name (Legal Business Name): CORALVILLE PROFESSIONAL SERVICES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S GILBERT ST
IOWA CITY IA
52240-4340
US

IV. Provider business mailing address

1840 S GILBERT ST
IOWA CITY IA
52240-4340
US

V. Phone/Fax

Practice location:
  • Phone: 319-248-5535
  • Fax: 319-519-6083
Mailing address:
  • Phone: 319-248-5535
  • Fax: 319-519-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MOHAMMED SAMUEL FILALI
Title or Position: OWNER/DIRECTOR
Credential: PHD MBA
Phone: 319-248-5535