WEST LAKES SURGERY CENTER LLC (NPI# 1104933696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104933696 |
| Entity Type | Organization |
| Organization Name | WEST LAKES SURGERY CENTER LLC |
| Practice Address |
12499 University Ave Suite 100 Clive IA 50325-8281 |
| Mailing Address |
2808 S Ingram Mill Rd Building B Springfield MO 65804-4042 |
| Practice Telephone | 5159745050 |
| Mailing Telephone | 4178892040 |
| Mailing Fax Number | 4178892041 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-06-04 |
| Authorized Official Name | DR. TERI S FORMANEK (PRESIDENT) |
| Authorized Official Telephone | 5153271555 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
NA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | CIGNA | F252394 | 01 |
| IA | WELLMARK BCBS | 61026 | 01 |
| IA | CARPENTERS DISTRICT COUN | F252394 | 01 |
| IA | 0610352 | 05 | |
| IA | FEDERAL EMPLOYEES HEALTH | 61026 | 01 |
| IA | MIDLANDS AETNA | F252394 | 01 |
| IA | WELLMARK HEALTH PLANS IA | 61026 | 01 |
| Street Address |
12499 UNIVERSITY AVE SUITE 100 |
| City | CLIVE |
| State | IA |
| Zip Code | 50325-8281 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033561295 | Paula Elizabeth Stageman | Nurse Practitioner | 12499 University Ave, Suite 280, Clive, IA 50325-8288 | 2016-07-11 |
| 1699177360 | Trisha Hittenmiller | Nurse Practitioner | 12499 University Ave, Ste 200, Clive, IA 50325-8281 | 2014-09-24 |
| 1275886053 | Beth Joann Macpherson | Audiologist | 12499 University Ave, Suite 200, Clive, IA 50325-8288 | 2012-10-18 |
| 1932432457 | Capital Orthopaedics and Sports Medicine PC | Orthopaedic Surgery | 12499 University Ave, Suite 210, Clive, IA 50325-8281 | 2009-09-16 |
| 1407085103 | Todd Charles Peterson | Orthopaedic Surgery | 12499 University Ave, Clive, IA 50325-8288 | 2009-07-02 |
| 1780818138 | Iowa Ear Center | Specialist | 12499 University Ave, Suite 200, Clive, IA 50325-8288 | 2009-05-13 |
| 1669669628 | Matthew D Danilson | Physician Assistant | 12499 University Ave, Suite 210, Clive, IA 50325-8281 | 2007-10-03 |
| 1861614646 | Matthew J Carfrae | Otolaryngology | 12499 University Ave, Ste 200, Clive, IA 50325-8281 | 2007-05-03 |
| 1962547356 | Jill A Frerichs | Podiatrist | 12499 University Ave, Suite 210, Clive, IA 50325-8288 | 2007-02-21 |
| 1497809859 | Gregory J Yanish | Surgery | 12499 University Ave, Ste. 210, Clive, IA 50325-8288 | 2007-01-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104449446 | Clive Behavioral Health LLC | Psychiatric Hospital | 1500 Nw 114th St, Clive, IA 50325 | 2020-05-21 |
| 1609426519 | Caroline Silva Pereira Lara Ribeiro | Occupational Therapist | 15500 Boston Parkway, Appt 110, Clive, IA 50325 | 2019-09-13 |
| 1487203873 | Karen Turnure | Technician | 4524 Nw 16th St, Clive, IA 50325 | 2019-09-09 |
| 1659920320 | Phs Walnut Ridge LLC | Skilled Nursing Facility | 1703 Campus Drive, Clive, IA 50325 | 2019-09-05 |
| 1700288834 | Lindsey White | Chiropractor | 12931 University Ave, Suite 103, Clive, IA 50325 | 2014-09-19 |
| 1811337389 | Metro West Learning Center, LLC | Counselor | 13300 Hickman Rd Ste 110, Clive, IA 50325 | 2013-06-28 |
| 1700110343 | Rodolfo Mallorca Legislador Sr. | Family Medicine | 1665 Nw 97th St., Clive, IA 50325 | 2009-09-30 |
| 1891961900 | Erin Ducharme | Dermatology | 16349 Sheridan Drive, Suite 101, Clive, IA 50325 | 2008-05-08 |
| 1174792873 | The Iowa Clinic PC | Prosthetic/Orthotic Supplier | 12655 University Ave, Ste 160, Clive, IA 50325 | 2008-02-27 |
| 1164623393 | Melisa Coaker | Internal Medicine | 1275 Nw 128th St, Ste 200, Clive, IA 50325 | 2007-05-28 |
| Find all providers in zip 50325 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609968478 | Iowa Endoscopy Center, Inc. | Clinic/Center | 1378 Nw 124th St, Suite 100, Clive, IA 50325-8151 | 2006-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467010736 | Mercy Surgery Center LLC | Clinic/Center | 1195 Boyson Rd Ste 3, Hiawatha, IA 52233-2214 | 2019-06-03 |
| 1649748708 | Ankeny Medical Park Surgery Center Lc | Clinic/Center | 3625 N Ankeny Blvd Ste J, Ankeny, IA 50023-4610 | 2018-11-07 |
| 1922514421 | Westown Ambulatory Surgery Center | Clinic/Center | 1300 37th St Ste 3, West Des Moines, IA 50266-1900 | 2017-12-19 |
| 1255500781 | Iowa City Ambulatory Surgical Center, LLC | Clinic/Center | 2963 Northgate Dr, Iowa City, IA 52245-9571 | 2008-02-28 |
| 1699856260 | Alegent Health - Mercy Hospital, Corning Iowa | Clinic/Center | 603 Rosary Dr, Corning, IA 50841-1683 | 2006-10-18 |
| 1083638647 | West Des Moines Ambulatory Surgical Center Inc | Clinic/Center | 2425 Westown Pkwy Ste 200, West Des Moines, IA 50266 | 2006-07-27 |
| 1902841398 | Mason City Ambulatory Surgery Center, LLC | Clinic/Center | 990 4th St Sw, Mason City, IA 50401-2861 | 2006-06-18 |
| 1881651206 | Gateway Surgery Center, L.L.C. | Clinic/Center | 841 Springdale Dr, Clinton, IA 52732-3579 | 2006-04-28 |
| 1639135346 | Surgery Centers of Des Moines Ltd | Clinic/Center | 717 Lyon St, Des Moines, IA 50309-5458 | 2006-04-21 |
| 1780651075 | Fox Eye Surgery, LLC | Clinic/Center | 1138 H Ave Ne, Cedar Rapids, IA 52402-4624 | 2006-03-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.