Provider Demographics
NPI:1073552428
Name:MEDICAL CENTER ANESTHESIOLOGISTS, P.C.
Entity Type:Organization
Organization Name:MEDICAL CENTER ANESTHESIOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-283-0463
Mailing Address - Street 1:411 LAUREL ST STE 3170
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3005
Mailing Address - Country:US
Mailing Address - Phone:515-283-0463
Mailing Address - Fax:515-283-0794
Practice Address - Street 1:411 LAUREL ST STE 3170
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3005
Practice Address - Country:US
Practice Address - Phone:515-283-0463
Practice Address - Fax:515-283-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0041889Medicaid
IA0041889Medicaid