Healthcare Provider Details

I. General information

NPI: 1689087215
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF FORT DODGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S MAIN ST
DAYTON IA
50530
US

IV. Provider business mailing address

24 S MAIN ST
DAYTON IA
50530-7698
US

V. Phone/Fax

Practice location:
  • Phone: 515-547-2974
  • Fax: 515-547-2976
Mailing address:
  • Phone: 515-576-6500
  • Fax: 515-576-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RENAE IRENE ELIZABETH KRUCKENBERG
Title or Position: CEO
Credential:
Phone: 515-576-6500