Provider Demographics
NPI:1831635119
Name:CEDAR VALLEY MEDICAL SPECIALISTS, PC
Entity Type:Organization
Organization Name:CEDAR VALLEY MEDICAL SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GILMORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:IREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-235-5390
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-3590
Mailing Address - Fax:319-233-1630
Practice Address - Street 1:5100 PRAIRIE PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8155
Practice Address - Country:US
Practice Address - Phone:319-833-5381
Practice Address - Fax:319-833-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies