Provider Demographics
NPI:1700856630
Name:FLOYD COUNTY MEMORIAL HOSPITAL COMMISSION
Entity type:Organization
Organization Name:FLOYD COUNTY MEMORIAL HOSPITAL COMMISSION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-228-6830
Mailing Address - Street 1:1501 S MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3444
Mailing Address - Country:US
Mailing Address - Phone:641-257-1184
Mailing Address - Fax:641-257-0688
Practice Address - Street 1:1501 S MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3444
Practice Address - Country:US
Practice Address - Phone:641-257-1184
Practice Address - Fax:641-257-0688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOYD CO MEM HOSP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-24
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34-0138H207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0635045Medicaid
IA0415935Medicaid
IA0415935Medicaid
IA0635045Medicaid
IA70075Medicare PIN