1033181086 NPI number — SOUTHWEST IOWA MENTAL HEALTH CENTER

Table of content: (NPI 1033181086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033181086 NPI number — SOUTHWEST IOWA MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST IOWA MENTAL HEALTH CENTER
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:
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:
1033181086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTIC
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50022-0034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-243-2606
Provider Business Mailing Address Fax Number:
712-243-2688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2307 OLIVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTIC
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50022-9768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-243-2606
Provider Business Practice Location Address Fax Number:
712-243-2688
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOLEY
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
712-243-2606

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D0893 . This is a "BCBS OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008938 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com