Basic Information
| Provider Information | |||||||||
| NPI: | 1508487547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHENANDOAH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PERSHING AVE | ||||||||
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| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122467400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 713 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TABOR | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516532031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122467400 | ||||||||
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| ProviderEnumerationDate: | 04/30/2020 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | KILEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EOB CASH SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7122467452 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.