Provider Demographics
NPI:1730529280
Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Entity type:Organization
Organization Name:IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-471-9300
Mailing Address - Street 1:3415 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6976
Mailing Address - Country:US
Mailing Address - Phone:563-742-4350
Mailing Address - Fax:563-742-4355
Practice Address - Street 1:3415 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6976
Practice Address - Country:US
Practice Address - Phone:563-742-4350
Practice Address - Fax:563-742-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies