COMMUNITY HEALTH CENTER OF FORT DODGE, INC. (NPI# 1588160089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588160089 |
| Entity Type | Organization |
| Organization Name | COMMUNITY HEALTH CENTER OF FORT DODGE, INC. |
| Other Organization Name | COMMUNITY HEALTH CENTER OF MASON CITY |
| Practice Address |
404 N Federal Ave Mason City IA 50401-3214 |
| Mailing Address |
126 N 10th St Fort Dodge IA 50501-3915 |
| Practice Telephone | 6414500601 |
| Practice Fax Number | 6414500612 |
| Mailing Telephone | 5155766500 |
| Mailing Fax Number | 5155762021 |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-10-12 |
| Authorized Official Name | RENAE IRENE ELIZABETH KRUCKENBERG (CEO) |
| Authorized Official Telephone | 5155766500 |
| Is Organization Subpart | Y |
| Parent Organization Name | COMMUNITY HEALTH CENTER OF FORT DODGE INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
261QF0400X | IA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Community Health Center of Mason City | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689087215 | Community Health Center of Fort Dodge, Inc. | Clinic/Center | 24 S Main St, Dayton, IA 50530 | 2014-06-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COMMUNITY HEALTH CENTER OF FORT DODGE, INC | 126 N 10th, Fort Dodge, IA 50501-3915 |
| Iowa Business Entities | COMMUNITY HEALTH CENTER OF FORT DODGE, INC. | 126 N 10th St, Fort Dodge, IA 50501 |
| Street Address |
404 N FEDERAL AVE |
| City | MASON CITY |
| State | IA |
| Zip Code | 50401-3214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528150661 | Nicolle L Medina | Nurse Practitioner | 404 N Federal Ave, Mason City, IA 50401-3214 | 2006-09-28 |
| 1699389098 | Rachael Irene Dolf | Counselor | 404 N Federal Ave, Mason City, IA 50401-3214 | 2020-09-02 |
| 1649882820 | Jill D Connell | Nurse Practitioner | 404 N Federal Ave, Mason City, IA 50401-3214 | 2020-08-19 |
| 1598307647 | Lynzy Marie Devary | Nurse Practitioner | 404 N Federal Ave, Mason City, IA 50401-3214 | 2019-10-10 |
| 1780165282 | Joleen Crook Frideres | Counselor | 404 N Federal Ave, Mason City, IA 50401-3214 | 2018-08-23 |
| 1992285662 | Leann Lord | Counselor | 404 N Federal Ave, Mason City, IA 50401-3214 | 2018-08-21 |
| 1336661677 | Taylor Lynn Stille | Nurse Practitioner | 404 N Federal Ave, Mason City, IA 50401-3214 | 2017-07-07 |
| 1679619373 | Brian Keith Burleson | Dentist | 404 N Federal Ave, Mason City, IA 50401 | 2007-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912544123 | Handicap Village | Intermediate Care Facility, Mentally Retarded | 1140 Limestone St, Mason City, IA 50401 | 2019-12-06 |
| 1548829989 | Debra Lynn Perzynski | Counselor | 103 E State St Suite 301, Brick and Tile Building, Mason City, IA 50401 | 2019-06-10 |
| 1851858617 | Four Oaks Family and Children's Services | Psychiatric Residential Treatment Facility | 80 North Eisenhower Ave, Mason City, IA 50401 | 2019-02-27 |
| 1578055521 | Alex Jon Uhlenhopp | Optometrist | 422 S Pierce Ave Ste 1, Mason City, IA 50401 | 2018-06-05 |
| 1538672985 | Bonnie Jean Burnett | Hearing Instrument Specialist | 704 16th St. Ne, Mason City, IA 50401 | 2017-11-08 |
| 1639691009 | Jeremy Baker | Counselor | 320 N Eisenhower Avenue, Mason City, IA 50401 | 2017-07-07 |
| 1437689940 | Medi-dent, Inc. | Psychiatry & Neurology | 1050 15th St. S.w., Suite 2, Mason City, IA 50401 | 2017-06-18 |
| 1922485283 | Jamie Lynn Heard | Social Worker | 50 N. Eisenhower Ave., Mason City, IA 50401 | 2015-05-06 |
| 1558756999 | Tyler Borchardt | Specialist/Technologist | 640 South Indiana Avenue, Mason City, IA 50401 | 2015-04-02 |
| 1811339203 | Siddiq A. Khan | General Practice | 520 S. Pierce Ave. Suite 150, Mason City, IA 50401 | 2013-07-25 |
| Find all providers in zip 50401 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1174139158 | Primary Health Care, Inc. | Clinic/Center | 2401 Se 14th St, Des Moines, IA 50320-1111 | 2020-09-16 |
| 1932710407 | River Hills Community Health Center Inc | Clinic/Center | 509 S Jefferson St, Sigourney, IA 52591-1521 | 2020-08-10 |
| 1033729876 | River Hills Community Health Center Inc | Clinic/Center | 907 E Pleasant Valley St, Sigourney, IA 52591-1866 | 2020-08-06 |
| 1316565625 | Rural Health Care, Inc. | Clinic/Center | 600 9th Ave N Ste 1, Sibley, IA 51249-1012 | 2020-07-13 |
| 1780208280 | River Hills Community Health Center Inc | Clinic/Center | 1417 A Ave E Ste 100, Oskaloosa, IA 52577-4280 | 2020-06-01 |
| 1124672373 | River Hills Community Health Center Inc. | Clinic/Center | 1000 S 6th St, Fairfield, IA 52556-3940 | 2019-07-26 |
| 1215581467 | River Hills Community Health Center Inc. | Clinic/Center | 404 W Fillmore Ave, Fairfield, IA 52556-4005 | 2019-07-26 |
| 1568016970 | River Hills Community Health Center Inc. | Clinic/Center | 605 E Broadway Ave, Fairfield, IA 52556-2900 | 2019-07-25 |
| 1396270831 | Primary Health Care, Inc. | Clinic/Center | 7555 Hickman Rd, Urbandale, IA 50322-4620 | 2017-04-21 |
| Find all providers with the same taxonomy | ||||
| City | MASON CITY |
| Zip Code | 50401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.