Healthcare Provider Details

I. General information

NPI: 1962457622
Provider Name (Legal Business Name): CEDAR VALLEY MEDICAL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 W RIDGEWAY AVE STE 107
WATERLOO IA
50701-4588
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-833-5907
  • Fax: 319-833-5908
Mailing address:
  • Phone: 319-833-5907
  • Fax: 319-833-5908

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