Healthcare Provider Details

I. General information

NPI: 1700486776
Provider Name (Legal Business Name): INNOVATIVE RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OFFICE PLAZA DRIVE N UNIT 115
WEST DES MOINES IA
50266-5026
US

IV. Provider business mailing address

PO BOX 2660
WATERLOO IA
50704-2660
US

V. Phone/Fax

Practice location:
  • Phone: 515-222-0550
  • Fax: 515-222-0544
Mailing address:
  • Phone: 800-728-3044
  • Fax: 319-260-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN TENTINGER
Title or Position: PRESIDENT
Credential: MD
Phone: 515-554-2887