Organization
SPRING PARK SURGERY CENTER L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA MAE MASAKOWSKI (BUSINESS OFFICE MANAGER)
(563) 359-1716
Entity
Organization
Contact information
Practice address
3319 SPRING ST, STE 202A, DAVENPORT, IA 52807-2125
(563) 355-6236
(563) 359-4634
Mailing address
3319 SPRING ST, STE 202A, DAVENPORT, IA 52807-2125
(563) 355-6236
(563) 359-4634
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0610154
—
IA
01
—
490004256
MEDICARE RAILROAD
IA
01
—
61015
WELLMARK BCBS
IA
Enumeration date
05/27/2005
Last updated
11/30/2011
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