Basic Information
| Provider Information | |||||||||
| NPI: | 1760645477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHALLTOWN MEDICAL & SURGICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 S 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501582924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417545151 | ||||||||
| FaxNumber: | 6417545172 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 S 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501582924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417545151 | ||||||||
| FaxNumber: | 6417545172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2008 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | WELTER | ||||||||
| AuthorizedOfficialFirstName: | KARY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | LIFELINE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6417545151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LIFELINE | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Emergency Medical Service Providers | Personal Emergency Response Attendant |
ID Information
| ID | Type | State | Issuer | Description | 1467523332 | 05 | IA | MEDICAID |