Provider Demographics
NPI:1598779357
Name:IOWA SPECIALTY HOSPITAL-CLARION
Entity Type:Organization
Organization Name:IOWA SPECIALTY HOSPITAL-CLARION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-532-9333
Mailing Address - Street 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-532-2811
Mailing Address - Fax:515-532-9336
Practice Address - Street 1:1316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2019
Practice Address - Country:US
Practice Address - Phone:515-532-2811
Practice Address - Fax:515-532-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA990177H261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0424507Medicaid
IA0293522Medicaid
IAI10211Medicare UPIN
IAH21584Medicare UPIN
IA0381980001Medicare NSC
IA0293522Medicaid
IAI10399Medicare UPIN
IA29352Medicare ID - Type UnspecifiedMEDICARE-PART B
IAI28108Medicare UPIN
IAP34309Medicare UPIN