Provider Demographics
NPI:1417004185
Name:NORTH IOWA COMMUNITY ACTION ORGANIZATION
Entity Type:Organization
Organization Name:NORTH IOWA COMMUNITY ACTION ORGANIZATION
Other - Org Name:NORTH IOWA COMMUNITY ACTION ORGANIZATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOERDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-423-8993
Mailing Address - Street 1:218 5TH ST SW
Mailing Address - Street 2:PO BOX 1627
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3840
Mailing Address - Country:US
Mailing Address - Phone:641-423-8993
Mailing Address - Fax:641-494-1716
Practice Address - Street 1:100 1ST ST NW, SUITE 200
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-423-5044
Practice Address - Fax:641-423-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1621944OtherNCPDP