MEDICARE: IOWA CENTRAL COMMUNITY COLLEGE

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1710187497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA CENTRAL COMMUNITY COLLEGE

Provider Business Mailing Address
First Line	:	330 AVENUE M
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5739
Country	:	US
Telephone Number	:	515-574-1327
Fax Number	:	515-576-5656

Provider Business Practice Location Address
First Line	:	330 AVENUE M
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5739
Country	:	US
Telephone Number	:	515-574-1327
Fax Number	:	515-576-5656

Authorized Official
Title or Position	:	PROGRAM COORDINATOR
Name	:	RENEE PIPER
Credential	:
Telephone Number	:	515-574-1335

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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Directions to “IOWA CENTRAL COMMUNITY COLLEGE ” Practice Location

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