IOWA PLASTIC SURGERY CENTER LC; NPI #1215916184

Contact Information

IOWA PLASTIC SURGERY CENTER LC

4334 E 53RD ST
DAVENPORT, IA 52807-3039

Phone: 563-322-8877
Fax: 563-322-8375
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Ambulatory Surgical	261QA1903X	49	Ambulatory Surgical Center

Indicates primary specialty

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NPI Profile & details for IOWA PLASTIC SURGERY CENTER LC

NPI Number 1215916184

LBN Legal business name IOWA PLASTIC SURGERY CENTER LC

Authorized official BENJAMIN VANRAALTE - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 01/10/2006

Last updated 02/15/2010 - About 16 years ago

Identifiers

IA	License #	29526
IA	Medicaid	IA0113241

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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