NPI 1104933696

West Lakes Surgery Center LLC

Organisation Ambulatory Surgical Clinic/Center Clive, IA

Practice location

Address: 12499 University Ave Suite 100, Clive, IA 50325-8281
Phone: (515) 974-5050
Mailing address: 2808 S Ingram Mill Rd Building B, Springfield, MO 65804-4042

Authorised official

Name: Teri S Formanek
Title: President
Phone: (515) 327-1555

Registered specialties

Ambulatory Surgical Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QA1903X Licence NA

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Registry record

NPI: 1104933696
Entity type: Organization
NPI issued: 23 Aug 2006
Record last updated: 4 Jun 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.