1184673972 NPI number — STATE UNIVERSITY OF IOWA

Table of content: (NPI 1184673972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184673972 NPI number — STATE UNIVERSITY OF IOWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE UNIVERSITY OF IOWA
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:
Provider Other Organization Name Type Code:
6
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:
1184673972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HAWKINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52242-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 LIONS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LIBERTY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52317-9575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-626-5680
Provider Business Practice Location Address Fax Number:
319-626-5687
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROUDABUSH
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR, PATIENT FINANCIAL SERVICE
Authorized Official Telephone Number:
319-384-2334

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH4834 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0223479 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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