Provider Demographics
NPI:1558351346
Name:NORTHERN IOWA UROLOGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHERN IOWA UROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-NORTHERN IOWA UROLOGICAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-234-2649
Mailing Address - Street 1:3410 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5735
Mailing Address - Country:US
Mailing Address - Phone:319-234-2649
Mailing Address - Fax:319-233-2430
Practice Address - Street 1:3410 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5735
Practice Address - Country:US
Practice Address - Phone:319-234-2649
Practice Address - Fax:319-233-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00516OtherBCBS OF IOWA
IACP8151OtherRAILROAD MEDICARE
IA0005165Medicaid
IA00516OtherMEDICARE
IA00516OtherBCBS OF IOWA