MEDICARE: STATE UNIVERSITY OF IOWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1215681283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE UNIVERSITY OF IOWA

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 10TH ST SE STE 2300
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-2467
Country	:	US
Telephone Number	:	319-731-1430
Fax Number	:	319-731-1435

Authorized Official
Title or Position	:	VP FOR MEDICAL AFFAIRS
Name	:	DR. JAY BROOKS JACKSON
Credential	:	MD
Telephone Number	:	319-335-8064

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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Directions to “STATE UNIVERSITY OF IOWA ” Practice Location

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