Provider Demographics
NPI:1538552914
Name:CORRIDOR SURGERY PLC
Entity type:Organization
Organization Name:CORRIDOR SURGERY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-665-2870
Mailing Address - Street 1:2751 OAKDALE BLVD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9749
Mailing Address - Country:US
Mailing Address - Phone:319-665-2870
Mailing Address - Fax:319-665-2872
Practice Address - Street 1:2751 OAKDALE BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9749
Practice Address - Country:US
Practice Address - Phone:319-665-2870
Practice Address - Fax:319-665-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35756208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0454504Medicaid
IA0454504Medicaid