Provider Demographics
NPI:1255568804
Name:UNIVERSITY OF IOWA COMMUNITY MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:UNIVERSITY OF IOWA COMMUNITY MEDICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROTEXTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-7642
Mailing Address - Street 1:218 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1202
Mailing Address - Country:US
Mailing Address - Phone:319-523-8205
Mailing Address - Fax:319-523-8840
Practice Address - Street 1:218 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1202
Practice Address - Country:US
Practice Address - Phone:319-523-8205
Practice Address - Fax:319-523-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health