Provider Demographics
NPI:1669477089
Name:DALLAS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:DALLAS COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LOOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-465-7653
Mailing Address - Street 1:610 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-2221
Mailing Address - Country:US
Mailing Address - Phone:515-465-3547
Mailing Address - Fax:515-465-2922
Practice Address - Street 1:610 10TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-2221
Practice Address - Country:US
Practice Address - Phone:515-465-3547
Practice Address - Fax:515-465-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA250157H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600759Medicaid
161322Medicare Oscar/Certification