=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689745259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IOWA CITY HEART CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 07/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 E JEFFERSON ST STE 400
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52245-2479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-339-3883
-----------------------------------------------------
Fax | 319-688-7304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 E JEFFERSON ST STE 400
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52245-2479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-339-3883
-----------------------------------------------------
Fax | 319-688-7304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. IAN MONTGOMERY
-----------------------------------------------------
Credential | CMPE
-----------------------------------------------------
Telephone | 319-688-7887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------