Healthcare Provider Details

I. General information

NPI: 1104879576
Provider Name (Legal Business Name): CENTRAL IOWA HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E UNIVERSITY AVE
DES MOINES IA
50316-2304
US

IV. Provider business mailing address

5409 NW 88TH ST SUITE 200
JOHNSTON IA
50131-2949
US

V. Phone/Fax

Practice location:
  • Phone: 515-265-4211
  • Fax: 515-309-5993
Mailing address:
  • Phone: 515-362-5980
  • Fax: 515-362-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J DEWERFF
Title or Position: CFO
Credential:
Phone: 515-241-6507