Organization
THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS, LLC
Active
Other names
Surgery Center Cedar Rapids
Organization subpart
No
Provider details
NPI number
Authorized official
KALLEMEYN SCOTT (EXECUTIVE DIRECTOR)
(319) 558-4801
Entity
Organization
Contact information
Practice address
1075 1ST AVENUE SE, CEDAR RAPIDS, IA 52402
(319) 558-4800
(319) 558-4806
Mailing address
1075 1ST AVENUE SE, CEDAR RAPIDS, IA 52402
(319) 558-4802
(319) 558-4806
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0610238
—
IA
01
—
61016
WELLMARK-BC/BS ID NUMBER
IA
Enumeration date
06/13/2005
Last updated
01/02/2019
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