Provider Demographics
NPI:1992279095
Name:PHYSMED IOWA LLC
Entity type:Organization
Organization Name:PHYSMED IOWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PANOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-926-4088
Mailing Address - Street 1:4905 S 107TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1965
Mailing Address - Country:US
Mailing Address - Phone:402-926-4088
Mailing Address - Fax:402-926-4197
Practice Address - Street 1:1130 S SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-2907
Practice Address - Country:US
Practice Address - Phone:402-320-3939
Practice Address - Fax:402-926-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health