Provider Demographics
NPI:1558412601
Name:PHYSICIANS' CLINIC OF IOWA, PC, DEPT OF NEUROLOGY
Entity Type:Organization
Organization Name:PHYSICIANS' CLINIC OF IOWA, PC, DEPT OF NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-398-1772
Mailing Address - Street 1:600 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2112
Mailing Address - Country:US
Mailing Address - Phone:319-398-1721
Mailing Address - Fax:319-399-2016
Practice Address - Street 1:600 7TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2112
Practice Address - Country:US
Practice Address - Phone:319-398-1721
Practice Address - Fax:319-399-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13448OtherWELLMARK GROUP NUMBER