Provider Demographics
NPI:1033183884
Name:SURGICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:COSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-236-4323
Mailing Address - Street 1:122 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1829
Mailing Address - Country:US
Mailing Address - Phone:641-236-4323
Mailing Address - Fax:641-236-3411
Practice Address - Street 1:122 4TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1829
Practice Address - Country:US
Practice Address - Phone:641-236-4323
Practice Address - Fax:641-236-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26205208600000X
IA18984208600000X
IA28246208800000X
IA001646363A00000X
IA001335363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0031088Medicaid
IA03108Medicare UPIN
IA4241460001Medicare NSC