Provider Demographics
NPI:1184691917
Name:MEDICAL IMAGING SERVICES OF NORTHWEST IOWA, P.C.
Entity type:Organization
Organization Name:MEDICAL IMAGING SERVICES OF NORTHWEST IOWA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:712-225-3368
Mailing Address - Street 1:300 SIOUX VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1205
Mailing Address - Country:US
Mailing Address - Phone:712-225-5101
Mailing Address - Fax:712-225-6880
Practice Address - Street 1:701 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1666
Practice Address - Country:US
Practice Address - Phone:712-364-3311
Practice Address - Fax:712-364-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7135Medicare PIN