Basic Information
| Provider Information | |||||||||
| NPI: | 1326063181 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IOWA SPECIALTY HOSPITAL- CLARION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CLARION CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 215 13TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322836 | ||||||||
| FaxNumber: | 5155322523 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 13TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322836 | ||||||||
| FaxNumber: | 5155322523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 12/18/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SIMONIN | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5155329333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/18/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC0050X | 990177H | IA | Y | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0283465 | 05 | IA | MEDICAID |