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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