Provider Demographics
NPI: | 1023045804 |
---|---|
Name: | CLARKE COUNTY PUBLIC HOSPITAL |
Entity Type: | Organization |
Organization Name: | CLARKE COUNTY PUBLIC HOSPITAL |
Other - Org Name: | CLARKE COUNTY HOSPITAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | THOMAS |
Authorized Official - Last Name: | THILGES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 641-342-5327 |
Mailing Address - Street 1: | 800 S FILLMORE ST |
Mailing Address - Street 2: | |
Mailing Address - City: | OSCEOLA |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50213-1694 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 641-342-2184 |
Mailing Address - Fax: | 641-342-5318 |
Practice Address - Street 1: | 800 S FILLMORE ST |
Practice Address - Street 2: | |
Practice Address - City: | OSCEOLA |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50213-1694 |
Practice Address - Country: | US |
Practice Address - Phone: | 641-342-2184 |
Practice Address - Fax: | 641-342-5318 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CLARKE COUNTY PUBLIC HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-06-27 |
Last Update Date: | 2023-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
33203 | Other | WELLMARK CRNA # | |
33203 | Other | WELLMARK CRNA # |