Healthcare Provider Details

I. General information

NPI: 1407800287
Provider Name (Legal Business Name): CEDAR VALLEY MEDICAL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 WEST 4TH STREET
WATERLOO IA
50701-4503
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-2701
  • Fax: 319-236-7993
Mailing address:
  • Phone: 319-235-5390
  • Fax: 319-233-1630

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: GILMORE JOHN IREY
Title or Position: CEO
Credential:
Phone: 319-235-5390