Provider Demographics
NPI:1568514297
Name:ELLSWORTH MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:ELLSWORTH MUNICIPAL HOSPITAL
Other - Org Name:ELLSWORTH FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-648-4631
Mailing Address - Street 1:322 1-2 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50106
Mailing Address - Country:US
Mailing Address - Phone:641-648-3202
Mailing Address - Fax:641-648-3203
Practice Address - Street 1:322 1-2 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126
Practice Address - Country:US
Practice Address - Phone:641-648-3202
Practice Address - Fax:641-648-3203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTH MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1922118090OtherNPI
IAA01141Medicare UPIN