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Radiology Consultants of Iowa, PLC
1956 1st Ave NE
Cedar Rapids, IA 52402
Phone:
(319) 832 - 1735
Fax:
(319) 832 - 1747
Email:
contactus@rciowa.com
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Error Summary
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1. Information
First Name
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M.I.
Last Name
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Name of person receiving service (If this is an event payment please enter name of attendee)
Account Number
*
The Radiology Consultants of Iowa account number (or event #)
Date of Birth
Must format with "/" i.e.02/02/1974 or you will get an invalid date error.
Notes or StatementID
Statement ID #. (If you are a registrant, please enter EVENT.)
Stmt Date
To link a payment to a specific statement
DateOfService
DATE OF SERVICE
Email Address
A receipt will be sent to this email address.
2. Payment Amount
Amount
3. Payment Method
Credit/Debit Card
Bank Account
Name on Card
*
Card Number
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Expiration Date
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Security Code
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Zip Code
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Account Type
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Routing Number
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Account Number
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Name On Check
Check Number
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