Provider Demographics
NPI:1508281205
Name:IOWA DIAGNOSTIC IMAGING & PROCEDURE L C
Entity Type:Organization
Organization Name:IOWA DIAGNOSTIC IMAGING & PROCEDURE L C
Other - Org Name:CENTRAL IOWA HOSPITAL CORP MEMBER
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-961-0453
Mailing Address - Street 1:4200 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 UNIVERSITY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5945
Practice Address - Country:US
Practice Address - Phone:515-961-0453
Practice Address - Fax:515-961-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2073326Medicaid
IAI7926Medicare PIN