Provider Demographics
NPI:1073898649
Name:KEOKUK COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:KEOKUK COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:IVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-622-2720
Mailing Address - Street 1:23019 HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-8341
Mailing Address - Country:US
Mailing Address - Phone:641-622-2720
Mailing Address - Fax:641-622-1187
Practice Address - Street 1:23019 HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-8341
Practice Address - Country:US
Practice Address - Phone:641-622-2720
Practice Address - Fax:641-622-1187
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEOKUK COUNTY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-14
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA540100H261QP2300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care