Provider Demographics
NPI:1700867108
Name:MARSHALLTOWN ANESTHESIOLOGISTS PLC
Entity Type:Organization
Organization Name:MARSHALLTOWN ANESTHESIOLOGISTS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-752-7149
Mailing Address - Street 1:312 E MAIN ST
Mailing Address - Street 2:SUITE 2300 MARSHALLTOWN ANESTHESIOLOGISTS PLC
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1888
Mailing Address - Country:US
Mailing Address - Phone:641-752-7149
Mailing Address - Fax:641-752-6320
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:SUITE 2300 MARSHALLTOWN ANESTHESIOLOGISTS PLC
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1888
Practice Address - Country:US
Practice Address - Phone:641-752-7149
Practice Address - Fax:641-752-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1017038Medicaid
CE9564OtherPGBA PR MEDICARE
IA41903OtherWELLMARK BCBS OF IA
CE9564OtherPGBA PR MEDICARE
IA1017038Medicaid
=========OtherCHAMPVA
IA=========OtherJOHN DEERE HEALTH