Provider Demographics
NPI:1043265424
Name:ENT MEDICAL SERVICES SLEEP CENTER PLC
Entity Type:Organization
Organization Name:ENT MEDICAL SERVICES SLEEP CENTER PLC
Other - Org Name:SLEEP & CT IMAGING CENTER OF IOWA CITY PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:VINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-338-2101
Mailing Address - Street 1:2901 NORTHGATE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9571
Mailing Address - Country:US
Mailing Address - Phone:319-338-2101
Mailing Address - Fax:319-338-1973
Practice Address - Street 1:2901 NORTHGATE DR
Practice Address - Street 2:SUITE A
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9571
Practice Address - Country:US
Practice Address - Phone:319-338-2101
Practice Address - Fax:319-338-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IANA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADE0738OtherRR MEDICARE
IA0283202Medicaid
IA0283202Medicaid