Provider Demographics
NPI:1902841398
Name:MASON CITY AMBULATORY SURGERY CENTER , LLC
Entity Type:Organization
Organization Name:MASON CITY AMBULATORY SURGERY CENTER , LLC
Other - Org Name:MASON CITY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-494-5280
Mailing Address - Street 1:990 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2861
Mailing Address - Country:US
Mailing Address - Phone:641-494-2000
Mailing Address - Fax:641-494-2018
Practice Address - Street 1:990 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2861
Practice Address - Country:US
Practice Address - Phone:641-494-2000
Practice Address - Fax:641-494-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
128273OtherHEALTH PARTNERS
IA0610337Medicaid
16-C0001024OtherHUMANA GOLD CHOICE
611158400OtherUS DEPT OF LABOR
9239479OtherDAKOTACARE
61024OtherBLUE CROSS & BLUE SHIELD
F249491OtherMIDLANDS CHOICE
SD0101OtherUNITED HEALTH CARE
611158400OtherUS DEPT OF LABOR