Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 24 S Main St, Dayton, Iowa |
Authorized Official Name and Position | Renae Irene Elizabeth Kruckenberg (CEO) |
Authorized Official Contact | 5155766500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
24 S Main St Dayton IA 50530-7698 Ph: (515) 576-6500 | 24 S Main St Dayton IA 50530 Ph: (515) 547-2974 |
NPI Number | 1689087215 |
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Provider Enumeration Date | 06/11/2014 |
Last Update Date | 03/01/2023 |
Medicare PECOS PAC ID | 1557378627 |
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Medicare Enrollment ID | O20180820001950 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689087215 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |