MEDICARE: DALLAS COUNTY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207Q00000X	Family Medicine Physician
4	261QP2300X	Primary Care Clinic/Center
5	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1194412478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS COUNTY HOSPITAL

Provider Business Mailing Address
First Line	:	610 10TH ST
Second Line	:
City	:	PERRY
State	:	IA
Zip	:	50220-2249
Country	:	US
Telephone Number	:	515-465-3547
Fax Number	:	515-465-7654

Provider Business Practice Location Address
First Line	:	507 14TH ST
Second Line	:
City	:	DALLAS CENTER
State	:	IA
Zip	:	50063-7738
Country	:	US
Telephone Number	:	515-992-3711
Fax Number	:	515-992-3803

Authorized Official
Title or Position	:	CFO
Name	:	DEBBIE MINER
Credential	:
Telephone Number	:	515-465-7653

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	06/02/2023

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Directions to “DALLAS COUNTY HOSPITAL ” Practice Location

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