North Corridor Internal Medicine P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

21179 Issued in IA

Legal business name

NORTH CORRIDOR INTERNAL MEDICINE P.C.

Practice address

2591 Holiday Rd
Coralville, IA 52241-3039

Phone

(319) 341-9778

Fax

(319) 341-9795

NPI assigned

Aug 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gregory Thomas Bozek, M.D.

Title

Owner/Manager/Provider

Phone

(319) 341-9778

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1508114992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2591 HOLIDAY RD",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522413039",
            "telephone_number": "319-341-9778",
            "fax_number": "319-341-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2591 HOLIDAY RD",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522413039",
            "telephone_number": "319-341-9778",
            "fax_number": "319-341-9795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CORRIDOR INTERNAL MEDICINE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "BOZEK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/MANAGER/PROVIDER",
        "authorized_official_telephone_number": "319-341-9778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "21179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1175943",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.