1083638647 NPI number — WEST DES MOINES AMBULATORY SURGICAL CENTER LLC

Table of content: (NPI 1083638647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083638647 NPI number — WEST DES MOINES AMBULATORY SURGICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST DES MOINES AMBULATORY SURGICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESTOWN AMBULATORY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083638647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 WESTOWN PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-1425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-221-1900
Provider Business Mailing Address Fax Number:
515-457-9180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 WESTOWN PKWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-221-1900
Provider Business Practice Location Address Fax Number:
515-457-9180
Provider Enumeration Date:
07/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEISHEIPL
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
515-221-1900

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025355700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6890119 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1154948 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0610097 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490004644 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61009 . This is a "WELLMARK BCBS OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".