Provider Demographics
NPI:1538212816
Name:CENTRAL IOWA FOOT CLINIC, P.C.
Entity type:Organization
Organization Name:CENTRAL IOWA FOOT CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-465-4821
Mailing Address - Street 1:1302 WARFORD ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-1622
Mailing Address - Country:US
Mailing Address - Phone:515-465-4821
Mailing Address - Fax:515-465-9417
Practice Address - Street 1:1302 WARFORD ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-1622
Practice Address - Country:US
Practice Address - Phone:515-465-4821
Practice Address - Fax:515-465-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00684213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1154302Medicaid
IAU65966Medicare UPIN
IAI3058Medicare ID - Type Unspecified