Healthcare Provider Details

I. General information

NPI: 1184550071
Provider Name (Legal Business Name): CLASS A MSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 DODGE RD NE STE 106
CEDAR RAPIDS IA
52402-2411
US

IV. Provider business mailing address

3315 WILLIAMS BLVD SW STE 2-112
CEDAR RAPIDS IA
52404-1478
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-7000
  • Fax:
Mailing address:
  • Phone: 319-768-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE JOHNSON
Title or Position: OWNER
Credential:
Phone: 319-768-7000