Northern Iowa Cardiovascular and Thoracic Surgery Clinic, PC

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

28663 Issued in IA

Legal business name

NORTHERN IOWA CARDIOVASCULAR AND THORACIC SURGERY CLINIC, PC

Practice address

1753 W Ridgeway Ave Ste 111
Waterloo, IA 50701-4588

Phone

(319) 233-6211

NPI assigned

Dec 3, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eromosele Anthony Otoadese, MD

Title

Owner

Phone

(319) 233-3044

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1942545975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2660",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042660",
            "telephone_number": "319-233-3044",
            "fax_number": "319-233-0722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1753 W RIDGEWAY AVE STE 111",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014588",
            "telephone_number": "319-233-6211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN IOWA CARDIOVASCULAR AND THORACIC SURGERY CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-03",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "OTOADESE",
        "authorized_official_first_name": "EROMOSELE",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-233-3044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IA",
            "license": "28663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.