NPIMap

Organization Active NPI

State University of Iowa

  • Clinical Medical Laboratory
  • Coralville, IA
National Provider Identifier
1851371561
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 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
Last updated
Sep 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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

Authorized official

Name
Mr. Wade K Alsous, PHD
Title
Clinic Lab Directo
Phone
(319) 335-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NONE Primary

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 names 1

  • State Hygienic Laboratory at the University of Iowa Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000959 IA Part B Supplier - Independent Clinical Laboratory 7618884230 Practice locations: Ankeny, IA; Coralville, IA

Other NPIs with the same Medicare PAC ID 20

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 20

National Provider Directory

National Provider Directory

Locations

2220 S Ankeny Blvd
Ankeny, IA 50023
Phone (515) 725-1600

2401 Coral Ct
Ste 5
Coralville, IA 52241

2490 Crosspark Rd
Coralville, IA 52241
Phone (319) 335-4500

105 Jessup Hall
Iowa City, IA 52242

1843 Lower Muscatine Rd
Iowa City, IA 52240
Phone (319) 467-8350

200 Hawkins Dr
Bldg 51300PFP
Iowa City, IA 52242

200 Hawkins Dr
Ste E202GH
Iowa City, IA 52242

322 Dental Science S
Iowa City, IA 52242
Phone (319) 335-7342

322 Dental Science S
Bldg 5
Iowa City, IA 52242

801 Newton Rd
Iowa City, IA 52242
Phone (319) 335-7499

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
University of Iowa Health Care Medical CenterIowa City, IA, CCN 160058 Hospital Other Jul 1, 1966
University of Iowa Health Care Medical CenterIowa City, IA, CCN 16S058 Hospital Other Jul 1, 1966
University of Iowa Health Care Medical Center DowntownIowa City, IA, CCN 160029 Hospital Other Jan 31, 2024
University of Iowa Health Care Medical Center Downtown Home HealthCoralville, IA, CCN 167181 Home health agency Other Jan 31, 2024

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 80

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1851371561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 CROSSPARK RD",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522414721",
            "telephone_number": "319-335-4500",
            "fax_number": "319-335-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 CROSSPARK RD",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522414721",
            "telephone_number": "319-335-4500",
            "fax_number": "319-335-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE UNIVERSITY OF IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2014-09-19",
        "status": "A",
        "authorized_official_last_name": "ALSOUS",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CLINIC LAB DIRECTO",
        "authorized_official_telephone_number": "319-335-4500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Hygienic Laboratory at the University of Iowa",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coralville, IA

Sources for this page

Verify at the official NPI Registry.