Basic Information
| Provider Information | |||||||||
| NPI: | 1053738765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELLSWORTH MUNICIPAL HOSPITAL | ||||||||
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| OtherOrganizationName: | WOMENS HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | ACKLEY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506011701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418472625 | ||||||||
| FaxNumber: | 6418472509 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 S OAK ST | ||||||||
| Address2: | |||||||||
| City: | IOWA FALLS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501269506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416487044 | ||||||||
| FaxNumber: | 6416487019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2014 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6416484631 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ELLSWORTH MUNICIPAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | B135725 | IA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207V00000X | 420156H | IA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.