1295064111 NPI number — PHYSICIANS CLINIC OF IOWA, PC

Table of content: (NPI 1295064111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295064111 NPI number — PHYSICIANS CLINIC OF IOWA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS CLINIC OF IOWA, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IOWA BLOOD AND CANCER CARE OF PCI MEDICATION DISPENSING SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295064111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3178
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52406-3178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-399-2096
Provider Business Mailing Address Fax Number:
319-399-2036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 10TH ST SE
Provider Second Line Business Practice Location Address:
DEPT OF HEMATOLOGY & ONCOLOGY
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52403-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-297-2900
Provider Business Practice Location Address Fax Number:
319-297-2969
Provider Enumeration Date:
12/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SPARENBORG
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
319-247-3003

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  1477682540 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16D1079312 . This is a "CLIA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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