1235247925 NPI number — POCAHONTAS COMMUNITY HOSPITAL

Table of content: (NPI 1235247925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235247925 NPI number — POCAHONTAS COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POCAHONTAS COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
POCAHONTAS COMMUNITY HOSPITAL AMBULANCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235247925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
606 NW 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCAHONTAS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50574-1099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-335-3501
Provider Business Mailing Address Fax Number:
712-335-4116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 NW 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCAHONTAS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50574-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-335-3501
Provider Business Practice Location Address Fax Number:
712-335-4116
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROETMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
712-335-3501

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  760133H , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0055509 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com