Provider Demographics
NPI:1003059841
Name:CEDAR VALLEY PODIATRY, PC
Entity Type:Organization
Organization Name:CEDAR VALLEY PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASTELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-277-4508
Mailing Address - Street 1:4508 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7958
Mailing Address - Country:US
Mailing Address - Phone:319-277-4508
Mailing Address - Fax:319-277-4508
Practice Address - Street 1:700 11TH ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3406
Practice Address - Country:US
Practice Address - Phone:641-228-5578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00423213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0413010001Medicare NSC