Provider Demographics
NPI:1629196241
Name:CLARINDA REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:CLARINDA REGIONAL HEALTH CENTER
Other - Org Name:CLARINDA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:K
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:51632-0217
Mailing Address - Country:US
Mailing Address - Phone:712-542-8305
Mailing Address - Fax:712-542-8311
Practice Address - Street 1:220 ESSIE DAVISON DR.
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2915
Practice Address - Country:US
Practice Address - Phone:712-542-8330
Practice Address - Fax:712-542-8397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARINDA REGIONAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10712Medicare Oscar/Certification
IAI10723Medicare PIN