Provider Demographics
NPI:1528026481
Name:IOWA DIAGNOSTIC IMAGING & PROCEDURE CENTER, L C
Entity Type:Organization
Organization Name:IOWA DIAGNOSTIC IMAGING & PROCEDURE CENTER, L C
Other - Org Name:IOWA RADIOLOGY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:K
Authorized Official - Last Name:TIEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-961-0453
Mailing Address - Street 1:12368 STRATFORD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8162
Mailing Address - Country:US
Mailing Address - Phone:515-226-9810
Mailing Address - Fax:515-226-8408
Practice Address - Street 1:12368 STRATFORD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8162
Practice Address - Country:US
Practice Address - Phone:515-226-9810
Practice Address - Fax:515-226-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
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
IA0273326Medicaid
IA0273326Medicaid