Basic Information
| Provider Information | |||||||||
| NPI: | 1821122623 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BELMOND COMMUNITY HOSPITAL | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | IOWA SPECIALTY HOSPITAL- BELMOND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 1ST ST SE | ||||||||
| Address2: | |||||||||
| City: | BELMOND | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504211201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414443500 | ||||||||
| FaxNumber: | 6414445554 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 1ST ST SE | ||||||||
| Address2: | |||||||||
| City: | BELMOND | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414443500 | ||||||||
| FaxNumber: | 6414445554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 01/20/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCDANIEL | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6414445621 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0289751 | 05 | IA | MEDICAID | 11754 | 01 | IA | MEDICARE PTAN | OTHER | WELLMARK | 01 | IA | 60007 | OTHER |