Provider Demographics
NPI:1700870649
Name:OBSTETRIC AND GYNECOLOGIC ASSOCIATES OF IOWA CITY PC
Entity Type:Organization
Organization Name:OBSTETRIC AND GYNECOLOGIC ASSOCIATES OF IOWA CITY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-337-3193
Mailing Address - Street 1:2769 HEARTLAND DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2732
Mailing Address - Country:US
Mailing Address - Phone:319-337-3193
Mailing Address - Fax:319-545-4570
Practice Address - Street 1:2769 HEARTLAND DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-337-3193
Practice Address - Fax:319-545-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0089979Medicaid
IA08997OtherBC/BS
IAA002306OtherCHAMPUS
IACP8135OtherRAILROAD
IA0089979Medicaid