Healthcare Provider Details

I. General information

NPI: 1548248321
Provider Name (Legal Business Name): STATE UNIVERSITY OF IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2211
  • Fax:
Mailing address:
  • Phone: 319-356-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE M MCKELVEY JR.
Title or Position: SR DIRECTOR OF GOVERNMENT REIMB
Credential:
Phone: 319-467-8549