Provider Demographics
NPI:1346241213
Name:POCAHONTAS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:POCAHONTAS COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-335-3501
Mailing Address - Street 1:606 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1028
Mailing Address - Country:US
Mailing Address - Phone:712-335-3501
Mailing Address - Fax:712-335-4116
Practice Address - Street 1:606 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1028
Practice Address - Country:US
Practice Address - Phone:712-335-3501
Practice Address - Fax:712-335-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA760133H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA60142OtherBLUE CROSS PROVIDER NUMBE
IA0601427Medicaid
IA60142OtherBLUE CROSS PROVIDER NUMBE