Healthcare Provider Details

I. General information

NPI: 1497007710
Provider Name (Legal Business Name): CENTRAL IOWA HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 PLEASANT ST.
DES MOINES IA
50309-1453
US

IV. Provider business mailing address

1206 PLEASANT ST.
DES MOINES IA
50309-1453
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-3434
  • Fax: 515-241-8631
Mailing address:
  • Phone: 515-241-3434
  • Fax: 515-241-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIA

VIII. Authorized Official

Name: MR. JOSEPH F. CORFITS JR.
Title or Position: C.F.O.
Credential:
Phone: 515-241-6470