Provider Demographics
NPI:1225209042
Name:DALLAS CENTER MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:DALLAS CENTER MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MCHOSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-992-3711
Mailing Address - Street 1:507 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50063-7738
Mailing Address - Country:US
Mailing Address - Phone:515-992-3711
Mailing Address - Fax:515-992-3803
Practice Address - Street 1:507 14TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS CENTER
Practice Address - State:IA
Practice Address - Zip Code:50063-7738
Practice Address - Country:US
Practice Address - Phone:515-992-3711
Practice Address - Fax:515-992-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA02579Medicare UPIN
IA163878Medicare Oscar/Certification