Provider Demographics
NPI:1003965336
Name:LORING HOSPITAL
Entity Type:Organization
Organization Name:LORING HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-662-7105
Mailing Address - Street 1:211 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583-2416
Mailing Address - Country:US
Mailing Address - Phone:712-662-7105
Mailing Address - Fax:712-662-3297
Practice Address - Street 1:211 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-2416
Practice Address - Country:US
Practice Address - Phone:712-662-7105
Practice Address - Fax:712-662-3297
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORING HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30179OtherBCBS CRNA PROVIDER SERV
IA0135574Medicaid
IAIB1017Medicare PIN