Provider Demographics
NPI:1609989581
Name:POCAHONTAS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:POCAHONTAS COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAVELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-335-3501
Mailing Address - Street 1:606 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1028
Mailing Address - Country:US
Mailing Address - Phone:712-335-3501
Mailing Address - Fax:712-335-4116
Practice Address - Street 1:606 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1028
Practice Address - Country:US
Practice Address - Phone:712-335-3501
Practice Address - Fax:712-335-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA760133H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12752OtherBC GROUP BILLING NUMBER
IA116053Medicaid
IA12752OtherBC GROUP BILLING NUMBER