MEDICARE: CENTRAL IOWA HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG3646	OTHER	IA	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477504371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL IOWA HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	5409 NW 88TH ST
Second Line	:	SUITE 200
City	:	JOHNSTON
State	:	IA
Zip	:	50131-2949
Country	:	US
Telephone Number	:	515-362-5980
Fax Number	:	515-362-5985

Provider Business Practice Location Address
First Line	:	2103 INGERSOLL AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312-5262
Country	:	US
Telephone Number	:	515-279-6424
Fax Number	:	515-279-3237

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOSEPH F. CORFITS JR.
Credential	:
Telephone Number	:	515-241-6507

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	05/22/2008

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