| Greg Evan Raecker, DO | |
|
1731 W Ridgeway Ave, Ste 101, Waterloo, IA 50701-4591 | |
| (319) 833-6001 | |
| (319) 833-6003 |
| Full Name | Greg Evan Raecker |
|---|---|
| Gender | Male |
| Speciality | Radiology - Diagnostic Radiology |
| Location | 1731 W Ridgeway Ave, Waterloo, Iowa |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225076029 | NPI | - | NPPES |
| 42141730793 | Other | IA | JOHN DEERE HLTH INS PLAN |
| 56258 | Other | IA | WELLMARK INS PLAN |
| 5030635 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 02087 (Iowa) | Primary |
| Entity Name | Allen Memorial Hospital Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1891772927 PECOS PAC ID: 4284546045 Enrollment ID: O20031211000480 |
| Mailing Address | Practice Location Address |
|---|---|
| Greg Evan Raecker, DO Po Box 2758, Waterloo, IA 50704-2758 Ph: (319) 833-6001 | Greg Evan Raecker, DO 1731 W Ridgeway Ave, Ste 101, Waterloo, IA 50701-4591 Ph: (319) 833-6001 |
James Vincent Connell Jr., M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 1825 Logan Ave, Waterloo, IA 50703 Phone: 319-235-3716 Fax: 319-233-1630 | |
Vandana Jain, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 200 E Ridgeway Ave, Waterloo, IA 50702 Phone: 319-272-2800 Fax: 319-272-2807 | |
Cassandra S Foens, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 200 E Ridgeway Ave, Waterloo, IA 50702 Phone: 319-272-2800 Fax: 319-272-2807 | |
Lawrence Arthur Liebscher, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 1731 W Ridgeway Ave, Ste 101, Waterloo, IA 50701 Phone: 319-833-6001 Fax: 319-833-6003 | |
Wayne Leroy Ventling Ii, DO Radiology Medicare: Medicare Enrolled Practice Location: 4150 Kimball Avenue, Waterloo, IA 50701 Phone: 219-235-5390 Fax: 319-233-1630 | |
Stephen Dale Frazier, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 1825 Logan Ave, Waterloo, IA 50703 Phone: 319-235-3716 Fax: 319-233-1630 |