Provider Demographics
NPI:1508846635
Name:GENERAL SURGERY, P.C.
Entity Type:Organization
Organization Name:GENERAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:REINKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-324-3298
Mailing Address - Street 1:1201 2ND AVE
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-1960
Mailing Address - Country:US
Mailing Address - Phone:712-324-3298
Mailing Address - Fax:712-324-8233
Practice Address - Street 1:1201 2ND AVE
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1960
Practice Address - Country:US
Practice Address - Phone:712-324-3298
Practice Address - Fax:712-324-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25857208600000X
IA29665208600000X
IA32663208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0186932Medicaid
IA0186932Medicaid