Provider Demographics
NPI:1265577019
Name:ORTHOPAEDIC AND SPORTS SURGERY CENTER PC
Entity type:Organization
Organization Name:ORTHOPAEDIC AND SPORTS SURGERY CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-226-2550
Mailing Address - Street 1:1601 NW 114TH ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7007
Mailing Address - Country:US
Mailing Address - Phone:515-226-2550
Mailing Address - Fax:515-226-2561
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:SUITE 142
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50325-7007
Practice Address - Country:US
Practice Address - Phone:515-226-2550
Practice Address - Fax:515-226-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32804207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty