Provider Demographics
NPI:1700967510
Name:SURGICAL CLINIC OF SOUTHERN IOWA, PC
Entity Type:Organization
Organization Name:SURGICAL CLINIC OF SOUTHERN IOWA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOKOL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-774-7730
Mailing Address - Street 1:2231 NW 108TH ST
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-3729
Mailing Address - Country:US
Mailing Address - Phone:515-334-7524
Mailing Address - Fax:515-334-7528
Practice Address - Street 1:1812 COURT AVE
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1904
Practice Address - Country:US
Practice Address - Phone:641-774-7730
Practice Address - Fax:515-334-7528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02942208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1188508Medicaid
IA2188508Medicaid
IA41239OtherWELLMARK
IA2188508Medicaid
IA41239OtherWELLMARK