Provider Demographics
NPI:1922252741
Name:CENTRAL IOWA HEALTHCARE
Entity Type:Organization
Organization Name:CENTRAL IOWA HEALTHCARE
Other - Org Name:CIH CONRAD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWNETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-754-5145
Mailing Address - Street 1:3 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2998
Mailing Address - Country:US
Mailing Address - Phone:641-754-5151
Mailing Address - Fax:641-844-6208
Practice Address - Street 1:105 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:IA
Practice Address - Zip Code:50621-7714
Practice Address - Country:US
Practice Address - Phone:641-366-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL IOWA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-06
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163421Medicare Oscar/Certification