Community Health Center of Fort Dodge Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY HEALTH CENTER OF FORT DODGE INC.

Practice address

330 Avenue M
Fort Dodge, IA 50501-5739

Phone

(515) 576-6500

Fax

(515) 576-1951

NPI assigned

Apr 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kathy J Wilkes, MBA

Title

Ceo

Phone

(515) 576-6500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Community Health Center of Fort Dodge Dental Clinic Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221609600000",
    "number": "1508030347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 N 10TH ST",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505013915",
            "telephone_number": "515-576-6500",
            "fax_number": "515-576-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 AVENUE M",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015739",
            "telephone_number": "515-576-6500",
            "fax_number": "515-576-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF FORT DODGE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-09-17",
        "status": "A",
        "authorized_official_last_name": "WILKES",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-576-6500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0490383",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Center of Fort Dodge Dental Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• John Clay, D.D.S.
• Robert Bruce Cochrane, DDS
• Stefanie Coleman, MS CCC SLP
• Community and Family Resources
• Community Health Center of Fort Dodge Inc.
• Community Health Center of Fort Dodge, Inc.
• Community School District
• Jennifer Condon
• Alexander Conley
• Lisa Conner, LMHC

• All providers in Fort Dodge, IA
• Federally Qualified Health Center (FQHC) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.