Provider Demographics
NPI:1255769006
Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity type:Organization
Organization Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-471-9227
Mailing Address - Street 1:115 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1013
Mailing Address - Country:US
Mailing Address - Phone:319-363-3565
Mailing Address - Fax:
Practice Address - Street 1:115 8TH ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1013
Practice Address - Country:US
Practice Address - Phone:319-363-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies