Healthcare Provider Details

I. General information

NPI: 1659208148
Provider Name (Legal Business Name): IOWA ORTHOPAEDIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 GRAND PRAIRIE PKWY
WAUKEE IA
68103-0728
US

IV. Provider business mailing address

2425 GRAND PRAIRIE PKWY
WAUKEE IA
50263-8994
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-8400
  • Fax: 515-248-8888
Mailing address:
  • Phone: 515-247-8400
  • Fax: 515-248-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TIARA JOHNSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 515-518-1633