Provider Demographics
NPI:1275746406
Name:OTTUMWA REGIONAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:OTTUMWA REGIONAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-684-2323
Mailing Address - Street 1:1001 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6427
Mailing Address - Country:US
Mailing Address - Phone:641-682-7511
Mailing Address - Fax:641-684-2324
Practice Address - Street 1:1001 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6427
Practice Address - Country:US
Practice Address - Phone:641-682-7511
Practice Address - Fax:641-684-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0043513Medicaid