MEDICARE: COMMUNITY HEALTH CENTER OF FORT DODGE INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508030347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CENTER OF FORT DODGE INC.

Provider Business Mailing Address
First Line	:	126 N 10TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-3915
Country	:	US
Telephone Number	:	515-576-6500
Fax Number	:	515-576-1951

Provider Business Practice Location Address
First Line	:	330 AVENUE M
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5739
Country	:	US
Telephone Number	:	515-576-6500
Fax Number	:	515-576-1951

Authorized Official
Title or Position	:	CEO
Name	:	MR. KATHY J WILKES
Credential	:	MBA
Telephone Number	:	515-576-6500

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	09/17/2008

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