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General NPI Number Information
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NPI Number | 1871782482
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Entity Type | Organization
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Legal Business Name | MESSERLY SURGICAL CARE PC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 709 W MAIN ST SUITE 187
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City | MANCHESTER
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State | IA
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Zip | 52057-1526
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Country | US
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Telephone | 563-927-7401
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Fax |
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Provider Business Mailing Address
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Address Line | 709 W MAIN ST
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City | MANCHESTER
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State | IA
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Zip | 52057-1526
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Country | US
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Telephone | 563-927-7401
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RANDALL MESSERLY
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Credential | D.O.
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Telephone | 563-927-7401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2484
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License Number State | IA
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