Provider Demographics
NPI:1558423640
Name:FLOYD VALLEY HOSPITAL
Entity Type:Organization
Organization Name:FLOYD VALLEY HOSPITAL
Other - Org Name:FLOYD VALLEY CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FISCAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-546-3338
Mailing Address - Street 1:714 LINCOLN ST NE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3314
Mailing Address - Country:US
Mailing Address - Phone:712-546-3398
Mailing Address - Fax:712-546-3352
Practice Address - Street 1:714 LINCOLN ST NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3314
Practice Address - Country:US
Practice Address - Phone:712-546-3398
Practice Address - Fax:712-546-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA750004H207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31457Medicare ID - Type Unspecified