Basic Information
Provider Information | |||||||||
NPI: | 1700879467 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE IOWA CLINIC ENDOSCOPY CENTER LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | THE IOWA CLINIC SURGERY AND ENDOSCOPY CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7147 VISTA DR STE 160 | ||||||||
Address2: |   | ||||||||
City: | WEST DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 502669313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5158759924 | ||||||||
FaxNumber: | 5158759923 | ||||||||
Practice Location | |||||||||
Address1: | 5950 UNIVERSITY AVE | ||||||||
Address2: | STE 180 | ||||||||
City: | WEST DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 50266 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5158759145 | ||||||||
FaxNumber: | 5158759146 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/29/2005 | ||||||||
LastUpdateDate: | 09/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARP | ||||||||
AuthorizedOfficialFirstName: | ERIC | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | BOARD CHAIR | ||||||||
AuthorizedOfficialTelephone: | 5158759100 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | DPM | ||||||||
NPICertificationDate: | 09/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
No ID Information.