Healthcare Provider Details

I. General information

NPI: 1164429775
Provider Name (Legal Business Name): USA HEALTHCARE FORT DODGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 14TH AVE N
FORT DODGE IA
50501-7016
US

IV. Provider business mailing address

728 14TH AVE N
FORT DODGE IA
50501-7016
US

V. Phone/Fax

Practice location:
  • Phone: 515-576-7226
  • Fax: 515-573-2865
Mailing address:
  • Phone: 515-576-7226
  • Fax: 515-573-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940900
License Number StateIA

VIII. Authorized Official

Name: MRS. STEPHANIE STEWART
Title or Position: BOOKKEEPER
Credential:
Phone: 515-576-7226