Provider Demographics
NPI:1689745259
Name:IOWA CITY HEART CENTER, PC
Entity Type:Organization
Organization Name:IOWA CITY HEART CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:319-688-7887
Mailing Address - Street 1:540 E JEFFERSON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2479
Mailing Address - Country:US
Mailing Address - Phone:319-339-3883
Mailing Address - Fax:319-688-7304
Practice Address - Street 1:540 E JEFFERSON ST STE 400
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2479
Practice Address - Country:US
Practice Address - Phone:319-339-3883
Practice Address - Fax:319-688-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0200769Medicaid
CA3899OtherRR MEDICARE PIN
IA0200769Medicaid