Provider Demographics
NPI:1063504702
Name:CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT
Entity Type:Organization
Organization Name:CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:563-589-4181
Mailing Address - Street 1:1300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-4732
Mailing Address - Country:US
Mailing Address - Phone:563-589-4181
Mailing Address - Fax:563-589-4299
Practice Address - Street 1:1300 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-4732
Practice Address - Country:US
Practice Address - Phone:563-589-4181
Practice Address - Fax:563-589-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0184986Medicaid