Basic Information
| Provider Information | |||||||||
| NPI: | 1427300201 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHENANDOAH MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | SHENANDOAH PHYSICIANS CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PERSHING AVE | ||||||||
| Address2: | PO BOX 380 | ||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122467240 | ||||||||
| FaxNumber: | 7122467357 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 JACK FOSTER DR | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516014586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122467240 | ||||||||
| FaxNumber: | 7122467357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 12/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7122461230 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 730065H | IA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 730065H | IA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261QR1300X | 730065H | IA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.