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General NPI Number Information
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NPI Number | 1275530271
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Entity Type | Organization
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Legal Business Name | TRI-STATE SURGERY CENTER, L.L.C.
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 1500 ASSOCIATES DR
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City | DUBUQUE
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State | IA
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Zip | 52002-2201
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Country | US
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Telephone | 563-584-4536
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Fax | 563-584-4526
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Provider Business Mailing Address
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Address Line | 1500 ASSOCIATES DR
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City | DUBUQUE
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State | IA
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Zip | 52002-2201
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Country | US
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Telephone | 563-584-4536
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Fax | 563-584-4526
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | BARBARA ANN PERLETH
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Credential |
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Telephone | 563-584-4506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 261QA1903X
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License Number State | IA
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