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 658, DES MOINES, IA 50303-0658
(515) 471-9300
(515) 471-9320
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0001X
Public Health Dentistry
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
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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