# STATE UNIVERSITY OF IOWA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UI Family Care Southeast Iowa City
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730138579
- **Authorized official:** PHILIP E ROUDABUSH (DIRECTOR, PATIENT FINANCIAL SERVICE)
- **Authorized official phone:** (319) 384-2334

## Contact information

- **Practice address:** 1130 S SCOTT BLVD, IOWA CITY, IA 52240-2907
- **Practice address phone:** (319) 339-7472
- **Mailing address:** 200 HAWKINS DR, IOWA CITY, IA 52242-1007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 03/01/2012