Provider Demographics
NPI:1164434080
Name:PALO ALTO COUNTY HOSPITAL
Entity Type:Organization
Organization Name:PALO ALTO COUNTY HOSPITAL
Other - Org Name:FAMILY PRACTICE CLINIC-WEST BEND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EINSWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-852-5401
Mailing Address - Street 1:3201 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-2516
Mailing Address - Country:US
Mailing Address - Phone:712-852-5500
Mailing Address - Fax:712-852-5409
Practice Address - Street 1:107 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:IA
Practice Address - Zip Code:50597-0000
Practice Address - Country:US
Practice Address - Phone:515-887-7891
Practice Address - Fax:515-887-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0257287Medicaid
IA48687OtherWELLMARK
IA0257287Medicaid