Provider Demographics
NPI:1891199147
Name:LAPAROSCOPIC SURGICAL SPECIALTIES,LLC
Entity Type:Organization
Organization Name:LAPAROSCOPIC SURGICAL SPECIALTIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-344-8333
Mailing Address - Street 1:3400 DEXTER CT
Mailing Address - Street 2:SUITE 118
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-344-8333
Mailing Address - Fax:563-344-8334
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:SUITE 118
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-344-8333
Practice Address - Fax:563-344-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty