Healthcare Provider Details

I. General information

NPI: 1497802912
Provider Name (Legal Business Name): DAVIS C.S.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W LOCUST ST STE 1
BLOOMFIELD IA
52537-1456
US

IV. Provider business mailing address

200 W LOCUST ST STE 1
BLOOMFIELD IA
52537-1456
US

V. Phone/Fax

Practice location:
  • Phone: 641-664-2200
  • Fax:
Mailing address:
  • Phone: 641-664-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0267708
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: ANNE MORGAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 641-664-2200