Provider Demographics
NPI:1770766081
Name:SURGICAL SERVICES OF MT. PLEASANT
Entity type:Organization
Organization Name:SURGICAL SERVICES OF MT. PLEASANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOTHAN-ZIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-385-6550
Mailing Address - Street 1:407 S WHITE ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2262
Mailing Address - Country:US
Mailing Address - Phone:319-385-6550
Mailing Address - Fax:319-385-6554
Practice Address - Street 1:407 S WHITE ST
Practice Address - Street 2:STE. 102
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2262
Practice Address - Country:US
Practice Address - Phone:319-385-6550
Practice Address - Fax:319-385-6554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGICAL SERVICES OF MT. PLEASANT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-10
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32860208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA49167OtherWELLMARK BLUE CROSS BLUE
IA049167Medicaid
IA049167Medicaid