Provider Demographics
NPI:1902859119
Name:CHARLES F DENHART MD PLC
Entity Type:Organization
Organization Name:CHARLES F DENHART MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:DENHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-283-1570
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:2600 GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5375
Practice Address - Country:US
Practice Address - Phone:515-283-1570
Practice Address - Fax:515-883-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA208100000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADH0033OtherRAILROAD MEDICARE
IA6301879Medicaid
IA7301879Medicaid
IA5301879Medicaid
IAI2149Medicare PIN
IA6301879Medicaid