MEDICARE: TOWNCREST INTERNAL MEDICINE, LLP

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBS	OTHER	IA	BCBS GROUP NO.

General Provider Information

NPI Number	:	1720005424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWNCREST INTERNAL MEDICINE, LLP

Provider Business Mailing Address
First Line	:	2460 TOWNCREST DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-6622
Country	:	US
Telephone Number	:	319-338-7862
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 TOWNCREST DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-6622
Country	:	US
Telephone Number	:	319-338-7862
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	STEVEN MICHAEL COOPER
Credential	:
Telephone Number	:	319-338-7862

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/17/2007

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