Provider Demographics
NPI:1619030467
Name:CEDAR VALLEY HAND SURGERY, PLC
Entity Type:Organization
Organization Name:CEDAR VALLEY HAND SURGERY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:319-364-2697
Mailing Address - Street 1:1953 1ST AVE SE
Mailing Address - Street 2:SUITE C4
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5328
Mailing Address - Country:US
Mailing Address - Phone:319-364-2697
Mailing Address - Fax:319-364-2312
Practice Address - Street 1:1953 1ST AVE SE
Practice Address - Street 2:SUITE C4
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5328
Practice Address - Country:US
Practice Address - Phone:319-364-2697
Practice Address - Fax:319-364-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24119207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3072694Medicaid
IA1183500001Medicare NSC
IA3072694Medicaid