=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922089002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROADLAWNS MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2005
-----------------------------------------------------
Last Update Date | 04/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 HICKMAN ROAD
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-282-2200
-----------------------------------------------------
Fax | 515-282-3234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 HICKMAN ROAD
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-282-2200
-----------------------------------------------------
Fax | 515-282-3234
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | JODY J JENNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-282-2234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------