Provider Demographics
NPI:1447221486
Name:ORTHOPAEDIC OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-224-5232
Mailing Address - Street 1:1600 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7700
Mailing Address - Country:US
Mailing Address - Phone:515-224-5232
Mailing Address - Fax:515-224-5234
Practice Address - Street 1:1600 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7700
Practice Address - Country:US
Practice Address - Phone:515-224-5232
Practice Address - Fax:515-224-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-29
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0610162Medicaid
IA0610162Medicaid