Provider Demographics
NPI:1508877283
Name:DUBUQUE SURGERY PC
Entity Type:Organization
Organization Name:DUBUQUE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-557-7000
Mailing Address - Street 1:1515 DELHI STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6314
Mailing Address - Country:US
Mailing Address - Phone:563-557-7000
Mailing Address - Fax:563-589-4050
Practice Address - Street 1:1515 DELHI STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6314
Practice Address - Country:US
Practice Address - Phone:563-557-7000
Practice Address - Fax:563-589-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
18457OtherBLUE SHIELD OF IOWA
IA18475Medicare ID - Type Unspecified
IA0184572Medicare ID - Type Unspecified