Basic Information
| Provider Information | |||||||||
| NPI: | 1437320595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IOWA SLEEP DISORDERS CENTER, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4060 WESTOWN PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502661010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152250188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 SE DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152250188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | ZORN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5152250188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | 21499 | IA | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 0167122 | 05 | IA | MEDICAID |