Provider Demographics
NPI:1346210408
Name:FLOYD COUNTY MEMORIAL HOSPITAL COMMISSION
Entity Type:Organization
Organization Name:FLOYD COUNTY MEMORIAL HOSPITAL COMMISSION
Other - Org Name:FLOYD COUNTY HOSP ER PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-228-6830
Mailing Address - Street 1:800 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616
Mailing Address - Country:US
Mailing Address - Phone:641-228-6830
Mailing Address - Fax:641-257-4336
Practice Address - Street 1:800 11TH ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616
Practice Address - Country:US
Practice Address - Phone:641-228-6830
Practice Address - Fax:641-257-4336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOYD COUNTY MEMORIAL HOSPITAL COMMISSION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-23
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA340138H207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0079475Medicaid
IA06942OtherWELLMARK BCBS
IA06942OtherWELLMARK BCBS