Healthcare Provider Details

I. General information

NPI: 1336107283
Provider Name (Legal Business Name): IOWA RADIOLOGY, P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12368 STRATFORD DR SUITE 300
CLIVE IA
50325-8162
US

IV. Provider business mailing address

12368 STRATFORD DR SUITE 300
CLIVE IA
50325-8162
US

V. Phone/Fax

Practice location:
  • Phone: 515-226-9810
  • Fax: 515-226-8408
Mailing address:
  • Phone: 515-226-9810
  • Fax: 515-226-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PENNY SHEPHERD
Title or Position: BILLING OFFICE MANAGER
Credential:
Phone: 515-226-7426