Provider Demographics
NPI:1639145527
Name:CORPORATE MEDICAL SERVICES OF SE IOWA PC
Entity Type:Organization
Organization Name:CORPORATE MEDICAL SERVICES OF SE IOWA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NEVLING
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:319-754-1555
Mailing Address - Street 1:823 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601
Mailing Address - Country:US
Mailing Address - Phone:319-754-1555
Mailing Address - Fax:319-752-5674
Practice Address - Street 1:823 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601
Practice Address - Country:US
Practice Address - Phone:319-754-1555
Practice Address - Fax:319-752-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA989261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine