Provider Demographics
NPI:1497890065
Name:IOWA CENTRAL INDUSTRIES
Entity Type:Organization
Organization Name:IOWA CENTRAL INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-576-2126
Mailing Address - Street 1:127 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5741
Mailing Address - Country:US
Mailing Address - Phone:515-576-2126
Mailing Address - Fax:515-576-2251
Practice Address - Street 1:127 AVENUE M
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5741
Practice Address - Country:US
Practice Address - Phone:515-576-2126
Practice Address - Fax:515-576-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0739508Medicaid