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General NPI Number Information
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NPI Number | 1043269079
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Entity Type | Organization
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Legal Business Name | IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 1791 HIGHWAY 64 E
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City | ANAMOSA
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State | IA
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Zip | 52205-2112
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Country | US
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Telephone | 319-462-3571
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Fax | 319-462-6043
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Provider Business Mailing Address
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Address Line | 8101 BIRCHWOOD COURT SUITE R
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City | JOHNSTON
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State | IA
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Zip | 50131-2930
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Country | US
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Telephone | 515-471-9243
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Fax | 515-471-9319
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Authorized Official
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Title or Position | COO
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Name | ERICK J LAINE
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Credential |
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Telephone | 515-471-9227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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