State University of Iowa
Organization Active NPI Clinical Medical Laboratory · Coralville, IA
NPI 1851371561 · NPPES record last updated Sep 19, 2014
Key facts
- NPI
- 1851371561
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- NONE
- Legal business name
- STATE UNIVERSITY OF IOWA
- Practice address
- 2490 Crosspark Rd
Coralville, IA 52241-4721 - Phone
- (319) 335-4500
- Fax
- (319) 335-4171
- NPI assigned
- Jan 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Wade K Alsous, PHD
- Title
- Clinic Lab Directo
- Phone
- (319) 335-4500
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 20
Practitioners 1,964
-
Richard G Burton, DDS MS
-
David G Gratton, DDS
-
Douglas Kendrick, DDS
-
Jeffrey Marschall, DMD, MS
-
Lama Abdel Wahed, MD
-
Brandon William Abel, DNP
-
Mahmoud Aboualaiwa, M.D.
-
Maen Aboul Hosn, M.D.
-
Thad E Abrams, MD
-
Dean A Abramson, MD
-
Ron O. Abrons, M.D.
-
Arwa Aburizik, M.B., B.S.
-
Anece Hong Adam, ARNP
-
Sayed Tauseef Ahmad Jan, MBBS
-
Ferhaan Ahmad, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| University of Iowa Health Care Medical Center |
Hospital | Other | Jul 1, 1966 |
| University of Iowa Health Care Medical Center |
Hospital | Other | Jul 1, 1966 |
| University of Iowa Health Care Medical Center Downtown |
Hospital | Other | Jan 31, 2024 |
| University of Iowa Health Care Medical Center Downtown Home Health |
Home health agency | Other | Jan 31, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040212000959 | IA | Part B Supplier - Independent Clinical Laboratory | 7618884230 | Practice locations: Ankeny, IA; Coralville, IA |
National Provider Directory
Locations
2490 Crosspark Rd
Coralville, IA 52241
Phone (319) 335-4500
801 Newton Rd
Iowa City, IA 52242
Phone (319) 335-7499
105 Jessup Hall
Iowa City, IA 52242
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | NONE | Yes |
Addresses
Primary practice location
2490 Crosspark Rd
Coralville, IA 52241-4721
Mailing address
2490 Crosspark Rd
Coralville, IA 52241-4721
Phone (319) 335-4500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410567200 | Medicaid | IA | |
| 0680447 | Medicaid | IA | |
| 200394010A | Medicaid | IA | |
| 17010 | Medicaid | IA | |
| 32906000 | Medicaid | IA | |
| 703280602 | Medicaid | IA | |
| WELLMARK | Other | IA | WELLMARK INSURANCE # |
| 5580770 | Medicaid | IA |
Other names
- State Hygienic Laboratory at the University of Iowa
Other providers in Coralville, IA
- State University of Iowa
- State University of Iowa
- State University of Iowa
- State University of Iowa
- State University of Iowa
- State University of Iowa
- State University of Iowa
- Melissa Steckly
- Kaitlin White Stein
- Stephanie N Seckel
All providers in Coralville, IA · Clinical Medical Laboratory in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2014. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.