Healthcare Provider Details

I. General information

NPI: 1124129804
Provider Name (Legal Business Name): CENTRAL IOWA OB/GYN SPECIALISTS OF DES MOINES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 WESTOWN PKWY SUITE 1101
WEST DES MOINES IA
50266-1427
US

IV. Provider business mailing address

2501 WESTOWN PKWY STE 1101
WEST DES MOINES IA
50266-1438
US

V. Phone/Fax

Practice location:
  • Phone: 515-267-8300
  • Fax: 515-267-8872
Mailing address:
  • Phone: 151-526-7830
  • Fax: 515-720-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: MRS. CHRISTINE G HOLLISTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 515-267-8300