1467511899 NPI number — MERCY TERRACE HILL SURGERY CENTER, LLC

Table of content: (NPI 1467511899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467511899 NPI number — MERCY TERRACE HILL SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY TERRACE HILL 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:
Provider Other Organization Name Type Code:
6
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:
1467511899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4926
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-323-6400
Provider Business Mailing Address Fax Number:
515-247-9549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 SE 37TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRIMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-323-6400
Provider Business Practice Location Address Fax Number:
515-247-9549
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
DIRECTOR OF SURGERY
Authorized Official Telephone Number:
515-247-9532

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: 0610147 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61014 . This is a "WELLMARK OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com