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General NPI Number Information
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NPI Number | 1508281205
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Entity Type | Organization
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Legal Business Name | IOWA DIAGNOSTIC IMAGING & PROCEDURE L C
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 4200 UNIVERSITY AVE SUITE 104
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City | WEST DES MOINES
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State | IA
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Zip | 50266-5945
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Country | US
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Telephone | 515-961-0453
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Fax | 515-961-2714
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Provider Business Mailing Address
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Address Line | 4200 UNIVERSITY AVE SUITE 104
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City | WEST DES MOINES
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State | IA
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Zip | 50266-5945
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING OFFICE COORDINATOR
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Name | CHERI TIEDEMANN
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Credential |
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Telephone | 515-961-0453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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