Healthcare Provider Details

I. General information

NPI: 1144646787
Provider Name (Legal Business Name): CENTRAL STATES MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1425
US

IV. Provider business mailing address

2425 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1425
US

V. Phone/Fax

Practice location:
  • Phone: 515-267-1819
  • Fax: 515-457-9180
Mailing address:
  • Phone: 515-267-1819
  • Fax: 515-401-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN LEDET
Title or Position: OWNER
Credential: MD
Phone: 515-991-6790