Provider Demographics
NPI:1013197060
Name:BROADLAWNS MEDICAL CENTER
Entity Type:Organization
Organization Name:BROADLAWNS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:515-282-2410
Mailing Address - Street 1:1801 HICKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314
Mailing Address - Country:US
Mailing Address - Phone:515-282-2200
Mailing Address - Fax:515-282-7856
Practice Address - Street 1:1801 HICKMAN ROAD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314
Practice Address - Country:US
Practice Address - Phone:515-282-2200
Practice Address - Fax:515-282-7856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROADLAWNS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-07
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
16101Medicare PIN
00826Medicare UPIN
IA016101Medicare Oscar/Certification