Provider Demographics
NPI:1477533362
Name:FORT MADISON HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:FORT MADISON HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-372-4920
Mailing Address - Street 1:1702 41ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-3269
Mailing Address - Country:US
Mailing Address - Phone:319-372-8021
Mailing Address - Fax:319-372-8163
Practice Address - Street 1:1702 41ST ST
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-3269
Practice Address - Country:US
Practice Address - Phone:319-372-8021
Practice Address - Fax:319-372-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA195314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801266Medicaid
IA165227Medicare Oscar/Certification