Provider Demographics
NPI:1609004811
Name:IOWA CITY FREE MEDICAL CLINIC
Entity Type:Organization
Organization Name:IOWA CITY FREE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VINOGRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-4459
Mailing Address - Street 1:2440 TOWNCREST DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6622
Mailing Address - Country:US
Mailing Address - Phone:319-337-4459
Mailing Address - Fax:319-341-0054
Practice Address - Street 1:2440 TOWNCREST DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6622
Practice Address - Country:US
Practice Address - Phone:319-337-4459
Practice Address - Fax:319-341-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service