Basic Information
Provider Information | |||||||||
NPI: | 1922087915 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KNOXVILLE COMMUNITY HOSPITAL INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KNOXVILLE HOSPITAL & CLINICS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1002 SOUTH LINCOLN ST | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | IA | ||||||||
PostalCode: | 501383155 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6418422151 | ||||||||
FaxNumber: | 6418421470 | ||||||||
Practice Location | |||||||||
Address1: | 1002 SOUTH LINCOLN ST | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | IA | ||||||||
PostalCode: | 501383155 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6418422151 | ||||||||
FaxNumber: | 6418421470 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/10/2006 | ||||||||
LastUpdateDate: | 10/26/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KINCAID | ||||||||
AuthorizedOfficialFirstName: | KEVIN | ||||||||
AuthorizedOfficialMiddleName: | L. | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 6418421400 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 630031H | IA | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 0601146 | 05 | IA |   | MEDICAID | 60114 | 01 | IA | WELLMARK BLUE CROSS IA | OTHER |