Provider Demographics
NPI:1588840466
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-648-7010
Mailing Address - Street 1:322 1/2 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-2106
Mailing Address - Country:US
Mailing Address - Phone:641-648-3202
Mailing Address - Fax:641-648-3203
Practice Address - Street 1:322 1/2 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-2106
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:2008-01-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18633261QP2300X
IAA1221491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15574OtherMEDICARE GROUP
IAI15576OtherMEDICARE
IA1129163Medicaid