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NPI Code Detail

MEDICARE: STATE UNIVERSITY OF IOWA

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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1730137050
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE UNIVERSITY OF IOWA
Provider Business Mailing Address
First Line : 2941 SIERRA CT SW
Second Line :
City : IOWA CITY
State : IA
Zip : 52240-8503
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 255 W LUCAS ST
Second Line :
City : MARENGO
State : IA
Zip : 52301-1331
Country : US
Telephone Number : 319-642-5213
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TERRY PROTEXTOR
Credential :
Telephone Number : 319-337-7642
Provider Enumeration Date : 05/05/2006
Last Update Date : 08/22/2020

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Directions to “STATE UNIVERSITY OF IOWA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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