NPIMap

Organization Active NPI

Great Lakes Surgery Center, LC

  • Ambulatory Surgical Clinic/Center
  • Spencer, IA
National Provider Identifier
1588726996
Registry record updated Mar 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
GREAT LAKES SURGERY CENTER, LC
Practice address
116 E 11TH St
Suite 202
Spencer, IA 51301-4364
Phone
(712) 262-7350
Fax
(712) 262-7351
NPI assigned
Dec 14, 2006
Last updated
Mar 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Benjamin Synhorst II, D.D.S.NPI 1598760605
Title
President
Phone
(712) 262-7350

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

116 E 11TH St
Suite 202
Spencer, IA 51301-4364

Mailing address

116 E 11TH St
Suite 202
Spencer, IA 51301-4364
Phone (712) 262-7350

Other identifiers 1

IdentifierTypeStateIssuer
0610345MedicaidIA

Other names 1

  • Great Lakes Surgery Center, LC Former legal business name

National Provider Directory

National Provider Directory

Locations

116 E 11th St
Ste 202
Spencer, IA 51301
Phone (712) 262-7350

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269302400000",
    "number": "1588726996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 E 11TH ST",
            "address_2": "SUITE 202",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014364",
            "telephone_number": "712-262-7350",
            "fax_number": "712-262-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E 11TH ST",
            "address_2": "SUITE 202",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014364",
            "telephone_number": "712-262-7350",
            "fax_number": "712-262-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SURGERY CENTER, LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2010-03-23",
        "status": "A",
        "authorized_official_last_name": "SYNHORST",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BENJAMIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-262-7350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0610345",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Surgery Center, LC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Spencer, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.