Provider Demographics
NPI:1265523062
Name:PEDIATRIC ASSOCIATES OF IOWA CITY AND CORALVILLE, LLP
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF IOWA CITY AND CORALVILLE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:GONZALO
Authorized Official - Last Name:GALINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-351-1448
Mailing Address - Street 1:605 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2426
Mailing Address - Country:US
Mailing Address - Phone:319-351-1448
Mailing Address - Fax:319-351-9367
Practice Address - Street 1:605 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2426
Practice Address - Country:US
Practice Address - Phone:319-351-1448
Practice Address - Fax:319-351-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0056341Medicaid
IA05634OtherWELLMARK BCBS GROUP NUMBE