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NPI Code Detail

MEDICARE: COMMUNITY HEALTH CENTER OF FORT DODGE, INC.

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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1720854847
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 : 515-576-2021
Provider Business Practice Location Address
First Line : 303 N MAIN ST
Second Line :
City : CLARION
State : IA
Zip : 50525-1441
Country : US
Telephone Number : 515-576-6500
Fax Number : 515-576-2021
Authorized Official
Title or Position : CEO
Name : RENAE IRENE ELIZABETH KRUCKENBERG
Credential :
Telephone Number : 515-576-6500
Provider Enumeration Date : 11/29/2023
Last Update Date : 11/29/2023

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Directions to “COMMUNITY HEALTH CENTER OF FORT DODGE, INC. ” Practice Location

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