Healthcare Provider Details

I. General information

NPI: 1275530271
Provider Name (Legal Business Name): TRI-STATE SURGERY CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

IV. Provider business mailing address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-4536
  • Fax: 563-584-4526
Mailing address:
  • Phone: 563-584-4536
  • Fax: 563-584-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number261QA1903X
License Number StateIA

VIII. Authorized Official

Name: BARBARA ANN PERLETH
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 563-584-4506