Healthcare Provider Details

I. General information

NPI: 1952304222
Provider Name (Legal Business Name): CENTRAL IOWA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S 4TH AVE
MARSHALLTOWN IA
50158-2998
US

IV. Provider business mailing address

3 S 4TH AVE
MARSHALLTOWN IA
50158-2998
US

V. Phone/Fax

Practice location:
  • Phone: 641-754-5151
  • Fax: 641-844-6208
Mailing address:
  • Phone: 641-754-5145
  • Fax: 641-844-6208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWNETT L. WILLIS
Title or Position: ACTING CEO
Credential:
Phone: 641-754-5145