Provider Demographics
NPI:1164429775
Name:USA HEALTHCARE FORT DODGE
Entity Type:Organization
Organization Name:USA HEALTHCARE FORT DODGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-576-7226
Mailing Address - Street 1:728 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7016
Mailing Address - Country:US
Mailing Address - Phone:515-576-7226
Mailing Address - Fax:515-573-2865
Practice Address - Street 1:728 14TH AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-7016
Practice Address - Country:US
Practice Address - Phone:515-576-7226
Practice Address - Fax:515-573-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA940900314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65156OtherBCBS PROV #
IA0804906Medicaid
IA65156OtherBCBS PROV #