Provider Demographics
NPI:1326448846
Name:IOWA MEDICAL & CLASSIFICATION CENTER
Entity Type:Organization
Organization Name:IOWA MEDICAL & CLASSIFICATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARBANS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEOL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:319-626-4278
Mailing Address - Street 1:2700 CORAL RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-4708
Mailing Address - Country:US
Mailing Address - Phone:319-626-4437
Mailing Address - Fax:319-665-6721
Practice Address - Street 1:2700 CORAL RIDGE AVE
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-4708
Practice Address - Country:US
Practice Address - Phone:319-626-4437
Practice Address - Fax:319-665-6721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18517261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health