MEDICARE: IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1245269646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	8101 BIRCHWOOD COURT
Second Line	:	SUITE R
City	:	JOHNSTON
State	:	IA
Zip	:	50131-2930
Country	:	US
Telephone Number	:	515-471-9243
Fax Number	:	515-471-9319

Provider Business Practice Location Address
First Line	:	623 PENNSYLVANIA AVE
Second Line	:
City	:	OTTUMWA
State	:	IA
Zip	:	52501-2116
Country	:	US
Telephone Number	:	641-682-7571
Fax Number	:	641-682-6550

Authorized Official
Title or Position	:	COO
Name	:	ERICK J LAINE
Credential	:
Telephone Number	:	515-471-9227

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	09/04/2012

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