1801953096 NPI number — CEDAR RAPIDS OB-GYN SPECIALISTS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801953096 NPI number — CEDAR RAPIDS OB-GYN SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR RAPIDS OB-GYN SPECIALISTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801953096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/15/2021
NPI Reactivation Date:
11/28/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 3RD AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52403-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-363-2682
Provider Business Mailing Address Fax Number:
319-363-1473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
788 8TH AVE SE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52401-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-363-2682
Provider Business Practice Location Address Fax Number:
319-363-1473
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DINNEL
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
319-730-9207

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0217364 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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