Organization
SPORTS MEDICINE DIAGNOSTIC CENTER LLC
Active
Other names
SOUTHERN IOWA OPEN MRI
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD D BERG M.D. (MANAGER)
(641) 683-1113
Entity
Organization
Contact information
Practice address
1005 PENNSYLVANIA AVE, SUITE 201B, OTTUMWA, IA 52501-6413
(641) 683-1113
(641) 683-1114
Mailing address
1005 PENNSYLVANIA AVE, SUITE 201B, OTTUMWA, IA 52501-6413
(641) 683-1113
(641) 683-1114
Taxonomy
Speciality
Code
Description
License number
State
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0210245
—
IA
01
—
22312
WELLMARK
IA
01
—
300133842
RAILROAD MEDICARE
IA
Enumeration date
03/23/2006
Last updated
02/22/2012
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