Provider Demographics
NPI:1780642694
Name:SOUTHEAST IOWA CARDIOLOGY
Entity Type:Organization
Organization Name:SOUTHEAST IOWA CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-754-4004
Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1682
Mailing Address - Country:US
Mailing Address - Phone:319-754-4004
Mailing Address - Fax:319-753-5498
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-754-4004
Practice Address - Fax:319-753-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0457549Medicaid
IA37984OtherBLUE CROSS BLUE SHIELD
IA37985OtherBLUE CROSS BLUE SHIELD
DC4706OtherRAILROAD MEDICARE
IAI11744Medicare ID - Type Unspecified