Provider Demographics
NPI:1851598767
Name:EASTERN IOWA SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:EASTERN IOWA SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-398-1721
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-2185
Mailing Address - Country:US
Mailing Address - Phone:319-362-4433
Mailing Address - Fax:319-362-4466
Practice Address - Street 1:275 10TH ST SE STE 3330
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2450
Practice Address - Country:US
Practice Address - Phone:319-362-4433
Practice Address - Fax:319-362-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherTAX ID