Provider Demographics
NPI:1093232605
Name:OSCEOLA COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:OSCEOLA COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-754-2574
Mailing Address - Street 1:115 CEDAR LANE
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-0258
Mailing Address - Country:US
Mailing Address - Phone:712-754-4611
Mailing Address - Fax:712-754-4612
Practice Address - Street 1:115 CEDAR LANE
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-0258
Practice Address - Country:US
Practice Address - Phone:712-754-4611
Practice Address - Fax:712-754-4612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSCEOLA COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
364SC1501X
IA167177364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Multi-Specialty
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0671776Medicaid