Provider Demographics
NPI:1760645477
Name:MARSHALLTOWN MEDICAL & SURGICAL CENTER
Entity Type:Organization
Organization Name:MARSHALLTOWN MEDICAL & SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIFELINE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-754-5151
Mailing Address - Street 1:3 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2924
Mailing Address - Country:US
Mailing Address - Phone:641-754-5151
Mailing Address - Fax:641-754-5172
Practice Address - Street 1:3 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2924
Practice Address - Country:US
Practice Address - Phone:641-754-5151
Practice Address - Fax:641-754-5172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFELINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1467523332Medicaid