Provider Demographics
NPI:1528031689
Name:CENTRAL IOWA SURGERY PC
Entity Type:Organization
Organization Name:CENTRAL IOWA SURGERY PC
Other - Org Name:CAPITOL HILL SURGERY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-265-1300
Mailing Address - Street 1:1301 PENN AVE
Mailing Address - Street 2:304
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2365
Mailing Address - Country:US
Mailing Address - Phone:515-265-1300
Mailing Address - Fax:515-265-2001
Practice Address - Street 1:1301 PENN AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2365
Practice Address - Country:US
Practice Address - Phone:515-265-1300
Practice Address - Fax:515-265-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0420265Medicaid
IA0420265Medicaid
IAI7511Medicare ID - Type UnspecifiedGROUP NUMBER