Provider Demographics
NPI:1497932842
Name:JILL H SCHOLZ
Entity Type:Organization
Organization Name:JILL H SCHOLZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-341-3668
Mailing Address - Street 1:501 12TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1774
Mailing Address - Country:US
Mailing Address - Phone:319-341-3668
Mailing Address - Fax:319-354-1014
Practice Address - Street 1:501 12TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1774
Practice Address - Country:US
Practice Address - Phone:319-341-3668
Practice Address - Fax:319-354-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3991030001Medicare NSC