| |
705 N 15th St Fort Dodge IA 50501-3344 | |
(515) 576-1176 | |
(515) 573-5295 |
Full Name | |
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Speciality | Clinic/center |
Location | 705 N 15th St, Fort Dodge, Iowa |
Authorized Official Name and Position | Ben Rogers (OWNER) |
Authorized Official Contact | 5155761176 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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705 N 15th St Fort Dodge IA 50501-3344 Ph: (515) 576-1176 | 705 N 15th St Fort Dodge IA 50501-3344 Ph: (515) 576-1176 |
NPI Number | 1750412318 |
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Provider Enumeration Date | 03/08/2007 |
Last Update Date | 07/15/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750412318 | NPI | - | NPPES |
0425488 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | AO5814 (Iowa) | Primary |
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