Provider Demographics
NPI:1992759328
Name:CEDAR VALLEY MEDICAL SPECIALISTS PC
Entity type:Organization
Organization Name:CEDAR VALLEY MEDICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTAMNENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-235-5390
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:800-334-6071
Mailing Address - Fax:319-334-6149
Practice Address - Street 1:1600 1ST ST EAST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-3155
Practice Address - Country:US
Practice Address - Phone:800-334-6071
Practice Address - Fax:319-334-6149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDAR VALLEY MEDICAL SPECIALISTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283283Medicaid
IA0283283Medicaid