Provider Demographics
NPI:1801815972
Name:ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Entity Type:Organization
Organization Name:ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Other - Org Name:ST ANTHONY REGIONAL HOSPITAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-794-5115
Mailing Address - Street 1:311 S CLARK ST
Mailing Address - Street 2:PO BOX 628
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3038
Mailing Address - Country:US
Mailing Address - Phone:712-792-2222
Mailing Address - Fax:712-792-3875
Practice Address - Street 1:311 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3038
Practice Address - Country:US
Practice Address - Phone:712-792-2222
Practice Address - Fax:712-792-3875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-19
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0276493Medicaid
IA0276493Medicaid