Provider Demographics
NPI:1619057361
Name:PULMONARY ASSOCIATES OF IOWA CITY, PC
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES OF IOWA CITY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-887-2873
Mailing Address - Street 1:2500 CROSSPARK RD STE W230
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-4710
Mailing Address - Country:US
Mailing Address - Phone:319-887-2873
Mailing Address - Fax:319-887-2870
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-887-2873
Practice Address - Fax:319-887-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39714OtherWELLMARK/ BCBS
IAI15989Medicare ID - Type Unspecified