Provider Demographics
NPI:1760590046
Name:CHILD HEALTH SPECIALTY CLINICS
Entity Type:Organization
Organization Name:CHILD HEALTH SPECIALTY CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRANTS & CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHUELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-384-6674
Mailing Address - Street 1:100 HAWKINS DR.
Mailing Address - Street 2:247-A CDD
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-384-6674
Mailing Address - Fax:319-356-3715
Practice Address - Street 1:100 HAWKINS DR.
Practice Address - Street 2:247-A CDD
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-384-6674
Practice Address - Fax:319-356-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0736264Medicaid
IA1053503755OtherNPI
IA0734871Medicaid
IA0797431Medicaid
IA0480202Medicaid
IA1609915628OtherNPI
IA1225177579OtherNPI