Provider Demographics
NPI:1962570358
Name:PHYSICIANS CHOICE DIAGNOSTIC SLEEP CENTER, LLC
Entity type:Organization
Organization Name:PHYSICIANS CHOICE DIAGNOSTIC SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:REUTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-365-0444
Mailing Address - Street 1:617 8TH AVENUE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2117
Mailing Address - Country:US
Mailing Address - Phone:319-365-0444
Mailing Address - Fax:319-365-1089
Practice Address - Street 1:617 8TH AVENUE SE
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2117
Practice Address - Country:US
Practice Address - Phone:319-365-0444
Practice Address - Fax:319-365-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies