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General NPI Number Information
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NPI Number | 1881238632
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Entity Type | Organization
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Legal Business Name | UNITED MEDICAL PARK ASC LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 1731 W RIDGEWAY AVE
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City | WATERLOO
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State | IA
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Zip | 50701-4595
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Country | US
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Telephone | 319-833-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CHASE CORPORATE DR STE 200
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City | HOOVER
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State | AL
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Zip | 35244-7060
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Country | US
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Telephone | 205-824-6250
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | LEE ANNE BLACKWELL
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Credential |
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Telephone | 205-824-6250
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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 |
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License Number State |
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