Provider Demographics
NPI:1275530271
Name:TRI-STATE SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:TRI-STATE SURGERY CENTER, L.L.C.
Other - Org Name:DUBUQUE REGIONAL AMBULATORY SURGICAL CENTER, L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERLETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-584-4506
Mailing Address - Street 1:1500 ASSOCIATES DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2201
Mailing Address - Country:US
Mailing Address - Phone:563-584-4536
Mailing Address - Fax:563-584-4526
Practice Address - Street 1:1500 ASSOCIATES DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2201
Practice Address - Country:US
Practice Address - Phone:563-584-4536
Practice Address - Fax:563-584-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QA1903X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA61010OtherBC/BS PROVIDER NUMBER
IA0610139Medicaid
IA61013Medicare PIN