Provider Demographics
NPI:1720256035
Name:IOWA SURGERY CENTER, P.C.
Entity type:Organization
Organization Name:IOWA SURGERY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSUKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MBA
Authorized Official - Phone:847-924-5530
Mailing Address - Street 1:1000 73RD ST STE 17
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1321
Mailing Address - Country:US
Mailing Address - Phone:515-223-2383
Mailing Address - Fax:515-225-8679
Practice Address - Street 1:1000 73RD ST STE 17
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1321
Practice Address - Country:US
Practice Address - Phone:515-223-2383
Practice Address - Fax:515-225-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1118091Medicaid
IAF95551Medicare UPIN
IA1118091Medicaid