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General NPI Number Information
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NPI Number | 1174073597
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Entity Type | Organization
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Legal Business Name | UNITYPOINT CLINIC URGENT CARE
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 802 KENYON RD SUITE A
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City | FORT DODGE
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State | IA
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Zip | 50501-5740
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Country | US
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Telephone | 515-574-8484
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Fax | 515-574-8483
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Provider Business Mailing Address
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Address Line | 802 KENYON RD SUITE A
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City | FORT DODGE
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State | IA
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Zip | 50501-5740
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Country | US
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Telephone | 515-574-8484
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Fax | 515-574-8483
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MS. LISA RENEE RANDALL
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Credential | RN
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Telephone | 515-574-8488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | A113462
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License Number State | IA
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