Organization
COMMUNITY HEALTH CENTER OF FORT DODGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENAE IRENE ELIZABETH KRUCKENBERG (CFO)
(515) 576-6500
Entity
Organization
Contact information
Practice address
126 N 10TH ST, FORT DODGE, IA 50501-3915
(515) 576-6500
(515) 576-1951
Mailing address
126 N 10TH ST, FORT DODGE, IA 50501-3915
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
1300
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0490383
—
IA
01
—
1622869
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/15/2006
Last updated
02/04/2022
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