Provider Demographics
NPI:1407381031
Name:UNITYPOINT HEALTH - MARSHALLTOWN
Entity Type:Organization
Organization Name:UNITYPOINT HEALTH - MARSHALLTOWN
Other - Org Name:UNITYPOINT HEALTH - FAMILY MEDICINE CLINIC - STATE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DELAGARDELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-235-3606
Mailing Address - Street 1:55 UNITYPOINT WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4749
Mailing Address - Country:US
Mailing Address - Phone:641-754-5145
Mailing Address - Fax:641-844-6208
Practice Address - Street 1:503 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:STATE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50247-7719
Practice Address - Country:US
Practice Address - Phone:641-844-2970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITYPOINT HEALTH - MARSHALLTOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-20
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health