Provider Demographics
NPI:1659547156
Name:IOWA ENT & SINUS SURGERY CENTER PC
Entity Type:Organization
Organization Name:IOWA ENT & SINUS SURGERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:FELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-576-3100
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-576-3100
Mailing Address - Fax:515-576-3104
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE F
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-576-3100
Practice Address - Fax:515-576-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26089207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty