1902841398 NPI number — MASON CITY AMBULATORY SURGERY CENTER , LLC

Table of content: (NPI 1902841398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902841398 NPI number — MASON CITY AMBULATORY SURGERY CENTER , LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASON CITY AMBULATORY SURGERY 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:
MASON CITY SURGERY 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:
1902841398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
990 4TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50401-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-494-2000
Provider Business Mailing Address Fax Number:
641-494-2018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 4TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-494-2000
Provider Business Practice Location Address Fax Number:
641-494-2018
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIER
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
641-494-5280

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: 128273 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0610337 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16-C0001024 . This is a "HUMANA GOLD CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611158400 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9239479 . This is a "DAKOTACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61024 . This is a "BLUE CROSS & BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: F249491 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: SD0101 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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