Provider Demographics
NPI:1932139243
Name:CEDAR VALLEY PODIATRY, PC
Entity Type:Organization
Organization Name:CEDAR VALLEY PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-277-4508
Mailing Address - Street 1:4508 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7958
Mailing Address - Country:US
Mailing Address - Phone:319-277-4508
Mailing Address - Fax:319-277-8908
Practice Address - Street 1:4508 CHADWICK RD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7958
Practice Address - Country:US
Practice Address - Phone:319-277-4508
Practice Address - Fax:319-277-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7692OtherMEDICARE GROUP NUMBER
IA0469726Medicaid
IAT01224Medicare UPIN
IA0413010003Medicare NSC
IAI7692Medicare PIN
IAT00904Medicare UPIN
IL213908OtherMEDICARE GROUP NUMBER IL