Healthcare Provider Details

I. General information

NPI: 1467686139
Provider Name (Legal Business Name): CAPITAL ORTHOPAEDICS AND SPORTS MEDICINE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST SUITE 142
DES MOINES IA
50325-7007
US

IV. Provider business mailing address

1601 NW 114TH ST SUITE 142
DES MOINES IA
50325-7007
US

V. Phone/Fax

Practice location:
  • Phone: 515-440-2676
  • Fax: 515-440-2677
Mailing address:
  • Phone: 515-440-2676
  • Fax: 515-440-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00693
License Number StateIA

VIII. Authorized Official

Name: DR. WILLIAM CHARLES JACOBSON
Title or Position: PARTNER
Credential: MD
Phone: 515-440-2676