Organization
STATE UNIVERSITY OF IOWA
Active
Organization
STATE UNIVERSITY OF IOWA
Active
Other names
State Hygienic Laboratory at the University of Iowa
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WADE K ALSOUS PHD (CLINIC LAB DIRECTO)
(319) 335-4500
Entity
Organization
Contact information
Practice address
2490 CROSSPARK RD, CORALVILLE, IA 52241-4721
(319) 335-4500
(319) 335-4171
Mailing address
2490 CROSSPARK RD, CORALVILLE, IA 52241-4721
(319) 335-4500
(319) 335-4171
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
NONE
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0680447
—
IA
05
—
17010
—
IA
05
—
200394010A
—
IA
05
—
32906000
—
IA
05
—
410567200
—
IA
05
—
5580770
—
IA
05
—
703280602
—
IA
01
—
WELLMARK
WELLMARK INSURANCE #
IA
Enumeration date
01/19/2006
Last updated
09/19/2014
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