Provider Demographics
NPI:1871776070
Name:METRO ANESTHESIA & PAIN MNGMT LLP
Entity type:Organization
Organization Name:METRO ANESTHESIA & PAIN MNGMT LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR- PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:515-221-9222
Mailing Address - Street 1:5901 WESTOWN PWKY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-221-9222
Mailing Address - Fax:515-221-0575
Practice Address - Street 1:5901 WESTOWN PWKY
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-221-9222
Practice Address - Fax:515-221-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1759207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0120733Medicaid
IA50171OtherWELLMARK
IA50171OtherWELLMARK