Provider Demographics
NPI:1801953096
Name:CEDAR RAPIDS OB-GYN SPECIALISTS, P.C.
Entity type:Organization
Organization Name:CEDAR RAPIDS OB-GYN SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINNEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-730-9207
Mailing Address - Street 1:1260 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4010
Mailing Address - Country:US
Mailing Address - Phone:319-363-2682
Mailing Address - Fax:319-363-1473
Practice Address - Street 1:788 8TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2106
Practice Address - Country:US
Practice Address - Phone:319-363-2682
Practice Address - Fax:319-363-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2024-03-25
Deactivation Date:2021-10-15
Deactivation Code:
Reactivation Date:2021-11-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0217364Medicaid
IA217364Medicare ID - Type Unspecified