Provider Demographics
NPI:1982836540
Name:PCI AUDIOLOGY CLINIC
Entity Type:Organization
Organization Name:PCI AUDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPARENBORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-398-1563
Mailing Address - Street 1:PO BOX 3178
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3178
Mailing Address - Country:US
Mailing Address - Phone:319-399-2022
Mailing Address - Fax:319-399-2014
Practice Address - Street 1:901 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2121
Practice Address - Country:US
Practice Address - Phone:319-399-2022
Practice Address - Fax:319-399-2014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS' CLINIC OF IOWA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00550237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA56461OtherGROUP NUMBER