Provider Demographics
NPI:1114954997
Name:CLARKE COUNTY PUBLIC HOSPITAL
Entity Type:Organization
Organization Name:CLARKE COUNTY PUBLIC HOSPITAL
Other - Org Name:CLARKE COUNTY HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:COO/CFP
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA200012H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
A5021301OtherJOHN DEERE HOSPITAL #
IA0600494Medicaid
60049OtherWELLMARK HOSPITAL #
IA0600494Medicaid