Provider Demographics
NPI:1538288352
Name:VILLISCA FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:VILLISCA FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-542-2176
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2625
Mailing Address - Country:US
Mailing Address - Phone:712-826-3003
Mailing Address - Fax:
Practice Address - Street 1:309 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:VILLISCA
Practice Address - State:IA
Practice Address - Zip Code:50864-1160
Practice Address - Country:US
Practice Address - Phone:712-826-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARINDA REGIONAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163464Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC