Provider Demographics
NPI:1831663822
Name:FORT DODGE HEALTH, INC.
Entity Type:Organization
Organization Name:FORT DODGE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-573-2020
Mailing Address - Street 1:1234 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4246
Mailing Address - Country:US
Mailing Address - Phone:515-573-2020
Mailing Address - Fax:
Practice Address - Street 1:1234 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4246
Practice Address - Country:US
Practice Address - Phone:515-573-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2178673Medicaid
IA06631OtherBLUE CROSS BLUE SHIELD