Provider Demographics
NPI:1598832719
Name:NORTH IOWA SLEEP LAB
Entity Type:Organization
Organization Name:NORTH IOWA SLEEP LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-424-0505
Mailing Address - Street 1:422 S PIERCE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2709
Mailing Address - Country:US
Mailing Address - Phone:641-424-0505
Mailing Address - Fax:641-424-0505
Practice Address - Street 1:422 S PIERCE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2709
Practice Address - Country:US
Practice Address - Phone:641-424-0505
Practice Address - Fax:641-424-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAF249988OtherMIDLANDS CHOICE
IAF249988OtherMIDLANDS CHOICE
IAI17276Medicare ID - Type Unspecified