Provider Demographics
NPI:1700486776
Name:INNOVATIVE RADIOLOGY, LLC
Entity Type:Organization
Organization Name:INNOVATIVE RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TENTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-554-2887
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2660
Mailing Address - Country:US
Mailing Address - Phone:800-728-3044
Mailing Address - Fax:319-260-2102
Practice Address - Street 1:7601 OFFICE PLAZA DRIVE N
Practice Address - Street 2:UNIT 115
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5026
Practice Address - Country:US
Practice Address - Phone:515-222-0550
Practice Address - Fax:515-222-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty