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General NPI Number Information
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NPI Number | 1689087215
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTER OF FORT DODGE, INC.
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 24 S MAIN ST
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City | DAYTON
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State | IA
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Zip | 50530
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Country | US
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Telephone | 515-547-2974
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Fax | 515-547-2976
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Provider Business Mailing Address
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Address Line | 24 S MAIN ST
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City | DAYTON
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State | IA
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Zip | 50530-7698
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Country | US
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Telephone | 515-576-6500
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Fax | 515-576-1951
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Authorized Official
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Title or Position | CEO
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Name | RENAE IRENE ELIZABETH KRUCKENBERG
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Credential |
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Telephone | 515-576-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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