Basic Information
| Provider Information | |||||||||
| NPI: | 1437152709 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHALLTOWN MEDICAL & SURGICAL CENTER | ||||||||
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| OtherOrganizationName: | BIOPATH LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 SOUTH 4TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501582998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417545145 | ||||||||
| FaxNumber: | 6418446208 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 SOUTH 4TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501582998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417545151 | ||||||||
| FaxNumber: | 6418446208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 04/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | WILLIS | ||||||||
| AuthorizedOfficialFirstName: | DAWNETT | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ACTING CEO | ||||||||
| AuthorizedOfficialTelephone: | 6417545145 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MARSHALLTOWN MEDICAL & SURGICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.