Healthcare Provider Details

I. General information

NPI: 1003807835
Provider Name (Legal Business Name): LAKEVIEW SURGERY CENTER LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 60TH STREET
WEST DES MOINES IA
50266
US

IV. Provider business mailing address

1750 60TH STREET
WEST DES MOINES IA
50266
US

V. Phone/Fax

Practice location:
  • Phone: 515-273-5240
  • Fax: 515-273-5241
Mailing address:
  • Phone: 515-273-5240
  • Fax: 515-273-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL P MOHAN
Title or Position: BOARD CHAIR
Credential: MD
Phone: 515-270-5240