Provider Demographics
NPI:1285784983
Name:PHYSICIANS' CLINIC OF IOWA, PC, DEPT OF ENT
Entity type:Organization
Organization Name:PHYSICIANS' CLINIC OF IOWA, PC, DEPT OF ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-398-1772
Mailing Address - Street 1:901 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2121
Mailing Address - Country:US
Mailing Address - Phone:319-399-2022
Mailing Address - Fax:319-399-2014
Practice Address - Street 1:901 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2121
Practice Address - Country:US
Practice Address - Phone:319-399-2022
Practice Address - Fax:319-399-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA56461OtherWELLMARK GROUP NUMBER