Provider Demographics
NPI:1558909572
Name:IOWA DERMATOLOGY CLINIC PLC
Entity Type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-226-8484
Mailing Address - Street 1:6800 LAKE DR STE 285
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2544
Mailing Address - Country:US
Mailing Address - Phone:515-226-3116
Mailing Address - Fax:
Practice Address - Street 1:1895 SE GRIMES BLVD.
Practice Address - Street 2:STE. 103
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-1277
Practice Address - Country:US
Practice Address - Phone:515-981-7040
Practice Address - Fax:515-259-1962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DERMATOLOGY CLINIC PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty