Provider Demographics
NPI:1386624815
Name:QUALITY SURGICENTER LLC
Entity type:Organization
Organization Name:QUALITY SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAHMADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-242-3208
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:CAMANCHE
Mailing Address - State:IA
Mailing Address - Zip Code:52730-0106
Mailing Address - Country:US
Mailing Address - Phone:563-242-3208
Mailing Address - Fax:563-242-4051
Practice Address - Street 1:2745 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7201
Practice Address - Country:US
Practice Address - Phone:563-242-3208
Practice Address - Fax:563-242-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0610121Medicaid
IA61012OtherBLUE CROSS
IA0610121Medicaid