Provider Demographics
NPI:1861416307
Name:DALLAS COUNTY HOSPITAL
Entity type:Organization
Organization Name:DALLAS COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-465-7600
Mailing Address - Street 1:610 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-2249
Mailing Address - Country:US
Mailing Address - Phone:515-465-3547
Mailing Address - Fax:515-465-2922
Practice Address - Street 1:610 10TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-2249
Practice Address - Country:US
Practice Address - Phone:515-465-3547
Practice Address - Fax:515-465-2922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALLAS COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207RC0000X, 261QC0050X
IA250157H367500000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access HospitalGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0269001Medicaid
CD6375Medicare PIN
IA0269001Medicaid
IA6267534Medicaid
IA3054171Medicaid
I9376Medicare PIN
IA4241497Medicaid
CD6375Medicare PIN
IAIB1359Medicare PIN
51083Medicare PIN
51082Medicare PIN
16799Medicare PIN
IA3054163Medicaid
IA0269001Medicaid
50832Medicare PIN
I10096Medicare PIN