Healthcare Provider Details

I. General information

NPI: 1194412478
Provider Name (Legal Business Name): DALLAS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 14TH ST
DALLAS CENTER IA
50063-7738
US

IV. Provider business mailing address

610 10TH ST
PERRY IA
50220-2249
US

V. Phone/Fax

Practice location:
  • Phone: 515-992-3711
  • Fax: 515-992-3803
Mailing address:
  • Phone: 515-465-3547
  • Fax: 515-465-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE MINER
Title or Position: CFO
Credential:
Phone: 515-465-7653