Healthcare Provider Details

I. General information

NPI: 1659573483
Provider Name (Legal Business Name): SOUTHEASTERN IOWA MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GEAR AVE
WEST BURLINGTON IA
52655-1691
US

IV. Provider business mailing address

PO BOX 540
WEST BURLINGTON IA
52655-0540
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3323
  • Fax:
Mailing address:
  • Phone: 319-768-3450
  • Fax: 319-768-3460

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: CHERYL CLAWSON
Title or Position: DIRECTOR
Credential:
Phone: 319-768-3628