Provider Demographics
NPI:1194035436
Name:STATE UNIVERSITY OF IOWA
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:MOTHER'S MILK BANK OF IOWA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-356-2652
Mailing Address - Street 1:119 2ND ST
Mailing Address - Street 2:STE 400
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2691
Mailing Address - Country:US
Mailing Address - Phone:319-356-2652
Mailing Address - Fax:319-384-9933
Practice Address - Street 1:119 2ND ST
Practice Address - Street 2:STE 400
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2691
Practice Address - Country:US
Practice Address - Phone:319-356-2652
Practice Address - Fax:319-384-9933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE UNIVERSITY OF IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies