Healthcare Provider Details

I. General information

NPI: 1639484256
Provider Name (Legal Business Name): IOWA PHYSICIANS CLINIC MEDICIAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 W RIDGEWAY SUITE 100
WATERLOO IA
50701-4591
US

IV. Provider business mailing address

8101 BIRCHWOOD COURT SUITE R
JOHNSTON IA
50131-2930
US

V. Phone/Fax

Practice location:
  • Phone: 319-833-6200
  • Fax: 319-833-6201
Mailing address:
  • Phone: 515-471-9243
  • Fax: 515-471-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROBIN L. MCNICHOLS
Title or Position: VP/COO
Credential:
Phone: 515-471-9201