Broadlawns Medical Center
Organization Active NPI Anesthesiology Physician · Des Moines, IA
NPI 1306068754 · NPPES record last updated Sep 30, 2008
Key facts
- NPI
- 1306068754
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 2785 (IA)
- Legal business name
- BROADLAWNS MEDICAL CENTER
- Practice address
- 1801 Hickman Road
Des Moines, IA 50314-1548 - Phone
- (515) 282-2200
- NPI assigned
- May 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Vincent J Mandracchia, DPM
- Title
- Chief Medical Officer
- Phone
- (515) 282-2562
Corporate family (same tax ID) 15
National Provider Directory
- Tax ID family
- Anesthesiology Service
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | 2785 | IA | Yes |
Addresses
Primary practice location
1801 Hickman Road
Des Moines, IA 50314-1548
Mailing address
1801 Hickman Rd
Des Moines, IA 50314-1548
Phone (515) 282-2200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0601013 | Medicaid | IA | |
| A5031401 | Other | IA | JOHN DEERE, UHC RIVER VAL |
| 6230290 | Other | IA | AETNA |
| 0265959 | Medicaid | IA | |
| 29705 | Other | IA | COVENTRY |
| 20023 | Other | IA | TRICARE |
Other names
- CRNA
Other providers in Des Moines, IA
- Broadlawns Hospital
- Broadlawns Medical Center
- Broadlawns Medical Center
- Broadlawns Medical Center
- Broadlawns Medical Center
- Broadlawns Medical Center
- Broadlawns Medical Center
- Broadlawns Medical Center
- Broadlawns Medical Center
- Broadlawns Medical Center
All providers in Des Moines, IA · Anesthesiology Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.