Healthcare Provider Details

I. General information

NPI: 1962570358
Provider Name (Legal Business Name): PHYSICIANS CHOICE DIAGNOSTIC SLEEP CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 8TH AVENUE SE SUITE B
CEDAR RAPIDS IA
52401-2117
US

IV. Provider business mailing address

617 8TH AVENUE SE SUITE B
CEDAR RAPIDS IA
52401-2117
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-0444
  • Fax: 319-365-1089
Mailing address:
  • Phone: 319-365-0444
  • Fax: 319-365-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LARRY JOHN REUTZEL
Title or Position: OWNER
Credential:
Phone: 319-365-0444