Provider Demographics
NPI:1164898219
Name:UNIVERSITY OF IOWA COMMUNITY MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:UNIVERSITY OF IOWA COMMUNITY MEDICAL SERVICES, INC
Other - Org Name:UIECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:UICMS BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, FAAP
Authorized Official - Phone:319-337-7642
Mailing Address - Street 1:2346 MORMON TREK BLVD
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4371
Mailing Address - Country:US
Mailing Address - Phone:319-337-7642
Mailing Address - Fax:319-339-1449
Practice Address - Street 1:2346 MORMON TREK BLVD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4371
Practice Address - Country:US
Practice Address - Phone:319-337-7642
Practice Address - Fax:319-339-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care