Provider Demographics
NPI:1851418586
Name:TOTAL HEALTH OF IOWA, INC
Entity Type:Organization
Organization Name:TOTAL HEALTH OF IOWA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SELENKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-988-9850
Mailing Address - Street 1:101 EDDYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IA
Mailing Address - Zip Code:50643-2243
Mailing Address - Country:US
Mailing Address - Phone:319-988-9850
Mailing Address - Fax:319-988-9872
Practice Address - Street 1:101 EDDYSTONE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IA
Practice Address - Zip Code:50643-2243
Practice Address - Country:US
Practice Address - Phone:319-988-9850
Practice Address - Fax:319-988-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11472Medicare ID - Type Unspecified
IAG16030Medicare UPIN
IAE42089Medicare UPIN