1114010873 NPI number — IOWA OPEN MRI

Table of content: (NPI 1114010873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114010873 NPI number — IOWA OPEN MRI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA OPEN MRI
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:
HAWKEYE DIAGNOSTIC IMAGING
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:
1114010873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1170
Provider Second Line Business Mailing Address:
DEPT 5299
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53201-1170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-793-9655
Provider Business Mailing Address Fax Number:
219-793-9692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CORALVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-337-7458
Provider Business Practice Location Address Fax Number:
319-337-7510
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
KIAYONA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
219-793-9655

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42645 . This is a "BLUE CROSS BLUE SHIELD WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 4081794 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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