Provider Demographics
NPI:1104008150
Name:SOUTHERN IOWA SURGICAL ASSOCIATES INC
Entity type:Organization
Organization Name:SOUTHERN IOWA SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-656-8100
Mailing Address - Street 1:707 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-2421
Mailing Address - Country:US
Mailing Address - Phone:641-856-8100
Mailing Address - Fax:641-437-1506
Practice Address - Street 1:707 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-2421
Practice Address - Country:US
Practice Address - Phone:641-856-8100
Practice Address - Fax:641-437-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-02
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29655208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6139519Medicaid
IA6139519Medicaid