1013066349 NPI number — LORING HOSPITAL

Table of content: (NPI 1013066349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013066349 NPI number — LORING HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORING 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:
Provider Other Organization Name Type Code:
6
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:
1013066349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAC CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50583-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-662-7105
Provider Business Mailing Address Fax Number:
712-662-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
SAC CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50583-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-662-7105
Provider Business Practice Location Address Fax Number:
712-662-3297
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STACY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
712-662-6383

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 61550 . This is a "BCBS HOSPICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0615500 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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