Provider Demographics
NPI:1649560368
Name:CERRO GORDO COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:CERRO GORDO COUNTY BOARD OF HEALTH
Other - Org Name:CERRO GORDO COUNTY DEPARTMENT OF PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-421-9300
Mailing Address - Street 1:2570 4TH ST SW STE 1
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4665
Mailing Address - Country:US
Mailing Address - Phone:641-421-9326
Mailing Address - Fax:
Practice Address - Street 1:2570 4TH ST SW STE 1
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4665
Practice Address - Country:US
Practice Address - Phone:641-421-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670547Medicaid
67054OtherWELLMARK BLUE CROSS BLUE SHIELD
67054OtherWELLMARK BLUE CROSS BLUE SHIELD