Provider Demographics
NPI:1083082606
Name:DALLAS COUNTY IOWA
Entity Type:Organization
Organization Name:DALLAS COUNTY IOWA
Other - Org Name:DALLAS COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-993-3750
Mailing Address - Street 1:25747 N AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-4420
Mailing Address - Country:US
Mailing Address - Phone:515-993-3750
Mailing Address - Fax:515-993-4949
Practice Address - Street 1:25747 N AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-4420
Practice Address - Country:US
Practice Address - Phone:515-993-3750
Practice Address - Fax:515-993-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670299Medicaid
IA0670299Medicaid