Provider Demographics
NPI:1164492450
Name:CHEST & VASCULAR SURGERY PC
Entity Type:Organization
Organization Name:CHEST & VASCULAR SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-324-3818
Mailing Address - Street 1:3385 DEXTER CT STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-324-3818
Mailing Address - Fax:563-326-4280
Practice Address - Street 1:3385 DEXTER CT STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-324-3818
Practice Address - Fax:563-326-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0262592Medicaid
IA0262592Medicaid