1164504551 NPI number — OSCEOLA COMMUNITY HOSPITAL,INC.

Table of content: (NPI 1164504551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164504551 NPI number — OSCEOLA COMMUNITY HOSPITAL,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSCEOLA COMMUNITY HOSPITAL,INC.
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:
OSCEOLA COMMUNITY HEALTH SERVICES
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:
1164504551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 CEDAR LANE
Provider Second Line Business Mailing Address:
P.O. BOX 258
Provider Business Mailing Address City Name:
SIBLEY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51249-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-754-4611
Provider Business Mailing Address Fax Number:
712-754-4612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 CEDAR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIBLEY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51249-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-754-4611
Provider Business Practice Location Address Fax Number:
712-754-4612
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DYKSTRA
Authorized Official First Name:
JANET
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
712-754-2574

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1-72-002327 , 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: 67177 . This is a "BLUE CROSS ID NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0671776 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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