Provider Demographics
NPI:1235121450
Name:WELAND CLINICAL LABORATORIES, P.C.
Entity Type:Organization
Organization Name:WELAND CLINICAL LABORATORIES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-366-1503
Mailing Address - Street 1:PO BOX 1924
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1924
Mailing Address - Country:US
Mailing Address - Phone:319-366-1503
Mailing Address - Fax:319-366-6976
Practice Address - Street 1:1911 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5320
Practice Address - Country:US
Practice Address - Phone:319-366-1503
Practice Address - Fax:319-366-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
690004433OtherRAILROAD MEDICARE
IA0258749Medicaid
MO706127008Medicaid
690004433OtherRAILROAD MEDICARE