Provider Demographics
NPI:1841249687
Name:STATE UNIVERSITY OF IOWA
Entity type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR JOPFS
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:STECKROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-356-3486
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 W JAYNE ST
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:IA
Practice Address - Zip Code:52755-7771
Practice Address - Country:US
Practice Address - Phone:319-629-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACH4836OtherRR MEDICARE
IA0223545Medicaid
IAI1421Medicare PIN