Provider Demographics
NPI:1649748708
Name:ANKENY MEDICAL PARK SURGERY CENTER LC
Entity Type:Organization
Organization Name:ANKENY MEDICAL PARK SURGERY CENTER LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF MANAGERS MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MULROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-241-4027
Mailing Address - Street 1:3625 N ANKENY BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4610
Mailing Address - Country:US
Mailing Address - Phone:515-965-2213
Mailing Address - Fax:515-446-2767
Practice Address - Street 1:3625 N ANKENY BLVD STE J
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4610
Practice Address - Country:US
Practice Address - Phone:515-965-2200
Practice Address - Fax:515-446-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical