Provider Demographics
NPI:1114390358
Name:STATE UNIVERSITY OF IOWA
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:PLASTIC & RECONSTRUCTIVE SURGERY CONSULTANTS OF UNIVERSITY OF IOWA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PATIENT FINANCIAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROUDABUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-384-2334
Mailing Address - Street 1:3705 RIVER RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7596
Mailing Address - Country:US
Mailing Address - Phone:319-393-1902
Mailing Address - Fax:
Practice Address - Street 1:3705 RIVER RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7596
Practice Address - Country:US
Practice Address - Phone:319-393-1902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty