Organization Name: | RENAL CENTER OF FORT DODGE, LLC |
NPI Number: | 1023397718 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD L CHATFIELD (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 2520 9th Ave S Fort Dodge |
State: | IA US |
Postal Code: | 505015440 |
Phone Number: | 5155746200 |
Fax Number: | |
NPI Enumeration Date: | 08/11/2011 |
NPI Last Update Date: | 03/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |