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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 LAINE (EXEC VP/COO)
(515) 471-9227
Entity
Organization
Contact information
Practice address
8101 BIRCHWOOD CT, SUITE N, JOHNSTON, IA 50131-2930
(515) 471-9300
(515) 471-9320
Mailing address
PO BOX 717, DES MOINES, IA 50303-0717
(515) 471-9300
(515) 471-9320
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366425274
—
IA
01
—
CC6519
RR MEDICARE
IA
01
—
CC6757
RR MEDICARE
IA
01
—
CC7716
RR MEDICARE
IA
01
—
CI6362
RR MEDICARE
IA
01
—
CJ3564
RR MEDICARE
IA
Enumeration date
08/05/2013
Last updated
08/05/2013
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