Healthcare Provider Details

I. General information

NPI: 1073610341
Provider Name (Legal Business Name): MISSISSIPPI VALLEY SLEEP DISORDER CENTER LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N BLUFF BLVD
CLINTON IA
52732-7119
US

IV. Provider business mailing address

1230 E RUSHOLME ST STE 303
DAVENPORT IA
52803-2400
US

V. Phone/Fax

Practice location:
  • Phone: 563-242-4233
  • Fax: 563-242-4231
Mailing address:
  • Phone: 563-322-2036
  • Fax: 563-323-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOANN CHAMBERLIN
Title or Position: BUSINESS MANAGER
Credential: RN, BS
Phone: 563-322-2036