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General NPI Number Information
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NPI Number | 1679657753
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Entity Type | Organization
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Legal Business Name | DES MOINES ORTHOPAEDIC SURGEONS PC MRI IMAGING CENTER
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6001 WESTOWN PARKWAY
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City | WEST DES MOINES
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State | IA
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Zip | 50266-7702
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Country | US
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Telephone | 515-224-5111
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Fax | 515-224-5140
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Provider Business Mailing Address
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Address Line | 6001 WESTOWN PARKWAY
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City | WEST DES MOINES
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State | IA
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Zip | 50266-7702
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Country | US
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Telephone | 515-224-5111
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Fax | 515-224-5140
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Authorized Official
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Title or Position | CORPORATE ADMINISTRATOR
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Name | MICHAEL L TEBO
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Credential |
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Telephone | 515-224-5131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ACR0340900992
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License Number State | IA
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