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General NPI Number Information
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NPI Number | 1548205941
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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 | 06/19/2006
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 1412 CEDAR ST
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City | TIPTON
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State | IA
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Zip | 52772-1100
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Country | US
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Telephone | 563-886-2182
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Fax | 563-886-2732
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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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