Healthcare Provider Details

I. General information

NPI: 1861416307
Provider Name (Legal Business Name): DALLAS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 10TH ST
PERRY IA
50220-2249
US

IV. Provider business mailing address

610 10TH ST
PERRY IA
50220-2249
US

V. Phone/Fax

Practice location:
  • Phone: 515-465-3547
  • Fax: 515-465-2922
Mailing address:
  • Phone: 515-465-3547
  • Fax: 515-465-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number250157H
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number250157H
License Number StateIA

VIII. Authorized Official

Name: ANGELA MORTOZA
Title or Position: CEO
Credential:
Phone: 515-465-7600