# CAPITAL ORTHOPAEDICS AND SPORTS MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932432457
- **Authorized official:** DR. WILLIAM CHARLES JACOBSON MD (SHAREHOLDER)
- **Authorized official phone:** (515) 440-2676

## Contact information

- **Practice address:** 12499 UNIVERSITY AVE, SUITE 210, CLIVE, IA 50325-8281
- **Practice address phone:** (515) 440-2676
- **Practice address fax:** (515) 440-2677
- **Mailing address:** 12499 UNIVERSITY AVE, SUITE 210, CLIVE, IA 50325-8281
- **Mailing address phone:** (515) 440-2676
- **Mailing address fax:** (515) 440-2677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | IA | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | 26239 | IA | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | 19337 | IA | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | 33389 | IA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 27587 | IA | — |
| 2086S0105X | Surgery of the Hand (Surgery) Physician | 37744 | IA | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 00693 | IA | — |

## Other

- **Enumeration date:** 09/16/2009
- **Last updated:** 01/22/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1932432457 | — | IA |