MEDICARE: IOWA CITY HOSPICE, INC.

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	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61507	OTHER	IA	WELLMARK BCBS OF IOWA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962447250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA CITY HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1526 SYCAMORE ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-6021
Country	:	US
Telephone Number	:	319-351-5665
Fax Number	:	319-351-5729

Provider Business Practice Location Address
First Line	:	1526 SYCAMORE ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-6021
Country	:	US
Telephone Number	:	319-351-5665
Fax Number	:	319-351-5729

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	KARLA KAMAL
Credential	:
Telephone Number	:	319-356-5665

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/28/2022

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