Organization
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN L. MCNICHOLS (VP/COO)
(515) 471-9201
Entity
Organization
Contact information
Practice address
1015 SOUTH HACKETT ROAD, SUITE 100, WATERLOO, IA 50701-3500
(319) 274-1000
(319) 292-6526
Mailing address
8101 BIRCHWOOD COURT, SUITE R, JOHNSTON, IA 50131-2930
(515) 471-9243
(515) 471-9319
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366425274
—
IA
01
—
CC6519
RR MEDICARE
IA
Enumeration date
05/03/2010
Last updated
12/30/2011
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