Healthcare Provider Details

I. General information

NPI: 1275624975
Provider Name (Legal Business Name): FLOYD COUNTY MEMORIAL HOSPITAL CRNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 11TH ST
CHARLES CITY IA
50616-3468
US

IV. Provider business mailing address

PO BOX 2400
WATERLOO IA
50704-2400
US

V. Phone/Fax

Practice location:
  • Phone: 641-228-6830
  • Fax: 641-257-4386
Mailing address:
  • Phone: 319-260-2100
  • Fax: 319-260-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD087130
License Number StateIA

VIII. Authorized Official

Name: MIKE ANDERSON
Title or Position: CFO
Credential:
Phone: 641-228-6830