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General NPI Number Information
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NPI Number | 1851371561
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Entity Type | Organization
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Legal Business Name | STATE UNIVERSITY OF IOWA
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 2490 CROSSPARK RD
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City | CORALVILLE
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State | IA
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Zip | 52241-4721
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Country | US
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Telephone | 319-335-4500
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Fax | 319-335-4171
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Provider Business Mailing Address
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Address Line | 2490 CROSSPARK RD
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City | CORALVILLE
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State | IA
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Zip | 52241-4721
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Country | US
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Telephone | 319-335-4500
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Fax | 319-335-4171
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Authorized Official
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Title or Position | CLINIC LAB DIRECTO
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Name | MR. WADE K ALSOUS
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Credential | PHD
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Telephone | 319-335-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | NONE
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License Number State |
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