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Organization
BROADLAWNS MEDICAL CENTER
Active
Organization
BROADLAWNS MEDICAL CENTER
Active
Other names
Broadlawns Medical Center Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT J MANDRACCHIA DPM (CHIEF MEDICAL OFFICER)
(515) 282-2562
Entity
Organization
Contact information
Practice address
1801 HICKMAN RD, DES MOINES, IA 50314-1505
(515) 282-2421
Mailing address
1801 HICKMAN ROAD, DES MOINES, IA 50314-1505
(515) 282-2421
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
07724
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0066068
—
IA
01
—
20023
TRICARE
IA
01
—
2601013
IOWA CARE
IA
01
—
29705
COVENTRY
IA
01
—
6230290
AETNA
IA
01
—
A5031401
JOHN DEERE UHC RIVER VALL
IA
Enumeration date
02/02/2006
Last updated
08/22/2020
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