Healthcare Provider Details

I. General information

NPI: 1659934180
Provider Name (Legal Business Name): CEDAR VALLEY MEDICAL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N 9TH AVE
VINTON IA
52349-2254
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-833-5922
  • Fax:
Mailing address:
  • Phone: 319-235-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VINAY KANTAMNENI
Title or Position: CEO
Credential: MD
Phone: 319-235-5390