Provider Demographics
NPI:1508481243
Name:HAMILTON COUNTY PUBLIC HOSPITAL
Entity Type:Organization
Organization Name:HAMILTON COUNTY PUBLIC HOSPITAL
Other - Org Name:VAN DIEST FAMILY HEALTH CLINIC OF FORT DODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEINRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-832-9400
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-0430
Mailing Address - Country:US
Mailing Address - Phone:515-832-7705
Mailing Address - Fax:
Practice Address - Street 1:119 AVENUE O W
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5634
Practice Address - Country:US
Practice Address - Phone:515-955-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMILTON COUNTY PUBLIC HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty