Healthcare Provider Details

I. General information

NPI: 1841515467
Provider Name (Legal Business Name): WOLFE CLINIC EYE SURGERY MANAGEMENT, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WESTOWN PKWY SUITE 100
WEST DES MOINES IA
50266-7705
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-8685
  • Fax: 515-223-5468
Mailing address:
  • Phone: 641-754-6200
  • Fax: 641-754-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEVIN L. SWARTZ
Title or Position: CEO
Credential:
Phone: 641-754-6200