Provider Demographics
NPI:1316264252
Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity type:Organization
Organization Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCNICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-471-9201
Mailing Address - Street 1:8101 BIRCHWOOD COURT
Mailing Address - Street 2:SUITE R
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2930
Mailing Address - Country:US
Mailing Address - Phone:515-471-9243
Mailing Address - Fax:515-471-9319
Practice Address - Street 1:1015 SOUTH HACKETT ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3500
Practice Address - Country:US
Practice Address - Phone:319-274-1000
Practice Address - Fax:319-292-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACC6519OtherRR MEDICARE
IA1366425274Medicaid
IA1100240074Medicare NSC
IA1366425274Medicaid