IOWA PLASTIC SURGERY CENTER LC NPI 1215916184

NPI Information

NPI: 1215916184
Provider Name: IOWA PLASTIC SURGERY CENTER LC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
4334 E 53RD ST
DAVENPORT, IA
ZIP 52807
Phone: (563) 322-8877
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IOWA PLASTIC SURGERY CENTER LC is an ambulatory surgical clinic center in Davenport, IA. IOWA PLASTIC SURGERY CENTER LC NPI is 1215916184. The provider is registered as an organization entity type.

The provider's business location address is:

4334 E 53RD ST
DAVENPORT, IA
ZIP 52807-039
Phone: (563) 322-8877
Fax: (563) 322-8375

The provider's authorized official is Benjamin Adam Vanraalte .
The authorized official title is Owner and has the following contact phone number (563) 322-8877.

The enumeration date for this NPI number is 1/10/2006 and was last updated on 2/15/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	29526	IOWA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	IA0113241	MEDICAID	IOWA
2	D86963	MEDICARE UPIN	IOWA
3	IA49704	MEDICARE ID-TYPE UNSPECIFIED	IOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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