Healthcare Provider Details

I. General information

NPI: 1164606364
Provider Name (Legal Business Name): CEDAR VALLEY MEDICAL SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 HUDSON RD
CEDAR FALLS IA
50614-0065
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-273-5275
  • Fax: 319-273-5295
Mailing address:
  • Phone: 319-235-5390
  • Fax: 319-233-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VINAY KANTAMNENI
Title or Position: CEO
Credential: MD
Phone: 319-235-5390