=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083835862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEBSTER COUNTY CASE MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 602 3RD AVE N
-----------------------------------------------------
City | FORT DODGE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50501-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-573-1485
-----------------------------------------------------
Fax | 515-573-1487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 602 3RD AVE N
-----------------------------------------------------
City | FORT DODGE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50501-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-573-1485
-----------------------------------------------------
Fax | 515-573-1487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | IRENE E BLAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-573-1485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 0208942
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------