Organization
BROADLAWNS MEDICAL CENTER
Active
Other names
CRNA
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT J MANDRACCHIA DPM (CHIEF MEDICAL OFFICER)
(515) 282-2562
Entity
Organization
Contact information
Practice address
1801 HICKMAN ROAD, DES MOINES, IA 50314-1548
(515) 282-2200
Mailing address
1801 HICKMAN RD, DES MOINES, IA 50314-1548
(515) 282-2200
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2785
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0265959
—
IA
05
—
0601013
—
IA
01
—
20023
TRICARE
IA
01
—
29705
COVENTRY
IA
01
—
6230290
AETNA
IA
01
—
A5031401
JOHN DEERE, UHC RIVER VAL
IA
Enumeration date
05/03/2007
Last updated
09/30/2008
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