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General NPI Number Information
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NPI Number | 1881679371
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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 | 12/07/2005
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 803 BROAD ST
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City | GRINNELL
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State | IA
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Zip | 50112-2153
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Country | US
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Telephone | 641-236-7419
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone | 319-356-1616
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Fax |
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Authorized Official
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Title or Position | SR DIRECTOR OF GOVERNMENT REIMB
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Name | MR. JOE M MCKELVEY JR.
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Credential |
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Telephone | 319-467-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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