Healthcare Provider Details

I. General information

NPI: 1750336491
Provider Name (Legal Business Name): CEDAR VALLEY MEDICAL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 PRAIRIE PKWY
CEDAR FALLS IA
50613-7971
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-859-8139
  • Fax: 319-349-8403
Mailing address:
  • Phone: 319-235-5390
  • Fax: 319-235-5607

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:

# 1
Identifier0285148
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: GILMORE JOHN IREY
Title or Position: CEO
Credential:
Phone: 319-235-5390