Provider Demographics
NPI:1376611103
Name:KEOKUK COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:KEOKUK COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:SMITHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-622-1146
Mailing Address - Street 1:23019 HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-8341
Mailing Address - Country:US
Mailing Address - Phone:641-622-2720
Mailing Address - Fax:641-622-1195
Practice Address - Street 1:23019 HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-8341
Practice Address - Country:US
Practice Address - Phone:641-622-2720
Practice Address - Fax:641-622-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27214282NC0060X
IA103223282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE92170Medicare UPIN
IAP06820Medicare UPIN