| State University Of Iowa | |
|
2510 Corridor Way Suite 6a Coralville IA 52241-7604 | |
| (319) 384-8500 | |
| Not Available |
| Full Name | State University Of Iowa |
|---|---|
| Speciality | Family Medicine |
| Location | 2510 Corridor Way, Coralville, Iowa |
| Authorized Official Name and Position | Philip E Roudabush (DIRECTOR, PFS) |
| Authorized Official Contact | 3193842334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State University Of Iowa 200 Hawkins Dr Iowa City IA 52242-1007 Ph: () - | State University Of Iowa 2510 Corridor Way Suite 6a Coralville IA 52241-7604 Ph: (319) 384-8500 |
| NPI Number | 1033424650 |
|---|---|
| Provider Enumeration Date | 08/09/2010 |
| Last Update Date | 03/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033424650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
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