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Organization
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Active
Organization
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICK J LAINE (VP/COO)
(515) 471-9227
Entity
Organization
Contact information
Practice address
600 N COLLEGE AVE, SUITE 120, GENESEO, IL 61254-1095
(309) 944-5342
(309) 945-4079
Mailing address
600 N COLLEGE AVE, SUITE 120, GENESEO, IL 61254-1095
(309) 944-5342
(309) 945-4079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
363A00000X
Physician Assistant
—
IL
363L00000X
Nurse Practitioner
—
IL
Other
Enumeration date
10/08/2015
Last updated
12/17/2015
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