Basic Information
| Provider Information | |||||||||
| NPI: | 1225167448 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSICIANS' CLINIC OF IOWA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3178 | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524063178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193625118 | ||||||||
| FaxNumber: | 3193640574 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 4TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193625118 | ||||||||
| FaxNumber: | 3193640574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 11/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3193981772 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.