1184723702 NPI number — ELLSWORTH MUNICIPAL HOSPITAL

Table of content: (NPI 1184723702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184723702 NPI number — ELLSWORTH MUNICIPAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLSWORTH MUNICIPAL 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:
EMH PHYSICIANS CLINIC
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:
1184723702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 TALBOTT ST STE 3
Provider Second Line Business Mailing Address:
EMH PHYSICIANS CLINIC
Provider Business Mailing Address City Name:
IOWA FALLS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50126-2379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-648-6491
Provider Business Mailing Address Fax Number:
641-648-7088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 TALBOTT ST STE 3
Provider Second Line Business Practice Location Address:
EMH PHYSICIANS CLINIC
Provider Business Practice Location Address City Name:
IOWA FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50126-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-648-6491
Provider Business Practice Location Address Fax Number:
641-648-7088
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
641-648-4631

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  420156H , 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: 0122176 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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