Provider Demographics
NPI:1518932821
Name:ORANGE CITY MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:ORANGE CITY MUNICIPAL HOSPITAL
Other - Org Name:MILLCREEK FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUTHMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-737-5274
Mailing Address - Street 1:5616 460TH ST
Mailing Address - Street 2:PO BOX 360
Mailing Address - City:PAULLINA
Mailing Address - State:IA
Mailing Address - Zip Code:51046-7516
Mailing Address - Country:US
Mailing Address - Phone:712-448-2000
Mailing Address - Fax:712-448-2004
Practice Address - Street 1:5616 460TH ST
Practice Address - Street 2:
Practice Address - City:PAULLINA
Practice Address - State:IA
Practice Address - Zip Code:51046-7516
Practice Address - Country:US
Practice Address - Phone:712-448-2000
Practice Address - Fax:712-448-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0634626Medicaid
IA63462OtherBLUE CROSS/BLUE SHIELD
IA0634626Medicaid