Provider Demographics
NPI:1225582505
Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Other - Org Name:UNITYPOINT CLINIC PEDIATRICS FORT DODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-471-9200
Mailing Address - Street 1:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-1455
Mailing Address - Country:US
Mailing Address - Phone:515-471-9300
Mailing Address - Fax:515-471-9319
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:STE D
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5744
Practice Address - Country:US
Practice Address - Phone:515-574-6855
Practice Address - Fax:515-573-7274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA168961Medicare Oscar/Certification