MEDICARE: BROADLAWNS MEDICAL CENTER

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1467850727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADLAWNS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1801 HICKMAN RD
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-1505
Country	:	US
Telephone Number	:	515-282-2296
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 14TH ST
Second Line	:
City	:	DALLAS CENTER
State	:	IA
Zip	:	50063-7738
Country	:	US
Telephone Number	:	515-992-3711
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	KARL VILUMS
Credential	:
Telephone Number	:	515-282-2296

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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