Healthcare Provider Details

I. General information

NPI: 1225089931
Provider Name (Legal Business Name): CENTRAL IOWA HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E EUCLID AVE
DES MOINES IA
50313-4726
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 515-262-0404
  • Fax: 515-262-0489
Mailing address:
  • Phone: 515-362-5980
  • Fax: 515-362-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH F. CORFITS JR.
Title or Position: CFO
Credential:
Phone: 515-241-6507