Basic Information
| Provider Information | |||||||||
| NPI: | 1477599678 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLARKE COUNTY PUBLIC HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CLARKE COUNTY HOSPITAL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S FILLMORE ST | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502131694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6413422184 | ||||||||
| FaxNumber: | 6413425318 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 S FILLMORE ST | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502131694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6413422184 | ||||||||
| FaxNumber: | 6413425318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 02/28/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | THILGES | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | COO/CFO | ||||||||
| AuthorizedOfficialTelephone: | 6413425327 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLARKE COUNTY PUBLIC HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 200012H | IA | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 0056911 | 05 | IA | MEDICAID |