Provider Demographics
NPI:1386680585
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:CFO
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?:Yes
Parent Organization LBN:CLARKE COUNTY PUBLIC HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
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
IA1619557Medicaid
AC4045731OtherDEA #