Provider Demographics
NPI:1497171920
Name:POCAHONTAS COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:POCAHONTAS COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:712-335-4142
Mailing Address - Street 1:99 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1629
Mailing Address - Country:US
Mailing Address - Phone:712-335-4142
Mailing Address - Fax:712-335-3581
Practice Address - Street 1:99 COURT SQ
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1629
Practice Address - Country:US
Practice Address - Phone:712-335-4142
Practice Address - Fax:712-335-3581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POCAHONTAS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1093818189Medicare UPIN