State University of Iowa
Organization Active NPI Family Medicine Physician · Sigourney, IA
NPI 1003864513 · NPPES record last updated Mar 1, 2012
Key facts
- NPI
- 1003864513
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- STATE UNIVERSITY OF IOWA
- Practice address
- 1314 S Stuart St
Sigourney, IA 52591-1154 - Phone
- (641) 622-3840
- NPI assigned
- May 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Philip E Roudabush
- Title
- Director, Patient Financial Service
- Phone
- (319) 384-2334
Other NPIs on the same Medicare enrollment 36
Practitioners 3
-
Michael Maharry, MD
-
Tiffany K Rickertsen, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031107000060 | IA | Part B Supplier - Clinic/Group Practice | 7618884230 |
Receives reassigned benefits from 2,348 practitioners 37 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
1314 S Stuart St
Sigourney, IA 52591
Phone (641) 622-3840
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1314 S Stuart St
Sigourney, IA 52591-1154
Mailing address
200 Hawkins Dr
Iowa City, IA 52242-1007
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CK8852 | Other | IA | RR MEDICARE |
| 0280032 | Medicaid | IA |
Other names
- UI Family Care Sigourney
Other providers in Sigourney, IA
- Sigourney Health Care LLC
- Sigourney Ia Skilled Nursing Facility, LLC
- Sigourney Ia Skilled Nursing Facility, LLC
- Sigourney Smiles
- Southeast Iowa Family Practice of Sigourney LLC
- State University of Iowa
- James Oliver Steele
- Stone Cottage Care Center LLC
- Jack Robert Vallandingham
- Lindsey Van Duyn
All providers in Sigourney, IA · Family Medicine Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.