Provider Demographics
NPI:1710988761
Name:STATE UNIVERSITY OF IOWA
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:UNIVERSITY OF IOWA HOSPITALS & CLINICS/AIR & MOBILE CRITICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-353-6360
Mailing Address - Street 1:200 HAWKINS DRIVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1082
Mailing Address - Country:US
Mailing Address - Phone:319-353-6360
Mailing Address - Fax:319-384-9184
Practice Address - Street 1:200 HAWKINS DRIVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1082
Practice Address - Country:US
Practice Address - Phone:319-353-6360
Practice Address - Fax:319-384-9184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE UNIVERSITY OF IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-02
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8000100341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA60058OtherWELLMARK BCBS
IA0231837Medicaid
IA60058OtherWELLMARK BCBS