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Organization
LAKEVIEW SURGERY CENTER LC
Active
Organization
LAKEVIEW SURGERY CENTER LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL P MOHAN MD (BOARD CHAIR)
(515) 270-5240
Entity
Organization
Contact information
Practice address
1750 60TH STREET, WEST DES MOINES, IA 50266
(515) 273-5240
(515) 273-5241
Mailing address
1750 60TH STREET, WEST DES MOINES, IA 50266
(515) 273-5240
(515) 273-5241
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
IA
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0610089
—
IA
01
—
61002
BLUE SHIELD PROVIDER NUMB
IA
Enumeration date
11/01/2005
Last updated
01/27/2010
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