Organization
SPORTS MEDICINE DIAGNOSTIC CENTER LLC
Active
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
Update your record
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