MEDICARE: IOWA CITY AMBULATORY SURGICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	NA	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255500781	OTHER	IA	BLUE CROSS OF IOWA

General Provider Information

NPI Number	:	1255500781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA CITY AMBULATORY SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	2963 NORTHGATE DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-9571
Country	:	US
Telephone Number	:	319-321-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2963 NORTHGATE DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-9571
Country	:	US
Telephone Number	:	319-321-0096
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. THOMAS A SIMPSON
Credential	:	M.D.
Telephone Number	:	319-321-0096

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	05/27/2021

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