Provider Demographics
NPI:1437152709
Name:MARSHALLTOWN MEDICAL & SURGICAL CENTER
Entity Type:Organization
Organization Name:MARSHALLTOWN MEDICAL & SURGICAL CENTER
Other - Org Name:BIOPATH LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWNETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-754-5145
Mailing Address - Street 1:3 SOUTH 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2998
Mailing Address - Country:US
Mailing Address - Phone:641-754-5145
Mailing Address - Fax:641-844-6208
Practice Address - Street 1:3 SOUTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2998
Practice Address - Country:US
Practice Address - Phone:641-754-5151
Practice Address - Fax:641-844-6208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALLTOWN MEDICAL & SURGICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-31
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10061Medicare PIN