Provider Demographics
NPI:1073939088
Name:CLARKE COUNTY
Entity Type:Organization
Organization Name:CLARKE COUNTY
Other - Org Name:CLARKE COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-342-3724
Mailing Address - Street 1:109 S MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213
Mailing Address - Country:US
Mailing Address - Phone:641-342-3724
Mailing Address - Fax:641-342-2603
Practice Address - Street 1:109 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213
Practice Address - Country:US
Practice Address - Phone:641-342-3724
Practice Address - Fax:641-342-2603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARKE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC1500X, 251K00000X
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67125OtherBLUE CROSS BLUE SHIELD
IA0671255Medicaid
IA0600020Medicaid
IA167125Medicare PIN
IAIB3143Medicare Oscar/Certification
IA0600020Medicaid