Provider Demographics
NPI:1497822795
Name:UNIVERSITY OF NORTHERN IOWA
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTHERN IOWA
Other - Org Name:UNIVERSITY OF NORTHERN IOWA STUDENT HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-273-7736
Mailing Address - Street 1:1227 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0221
Mailing Address - Country:US
Mailing Address - Phone:319-273-2009
Mailing Address - Fax:319-273-7030
Practice Address - Street 1:1227 W 27TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0221
Practice Address - Country:US
Practice Address - Phone:319-273-2009
Practice Address - Fax:319-273-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFEDERAL TAX ID