Provider Demographics
NPI:1902834716
Name:LUCAS COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:LUCAS COUNTY HEALTH CENTER
Other - Org Name:HUMESTON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-774-3000
Mailing Address - Street 1:1200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1210
Mailing Address - Country:US
Mailing Address - Phone:641-774-3000
Mailing Address - Fax:
Practice Address - Street 1:123 BROAD ST
Practice Address - Street 2:
Practice Address - City:HUMESTON
Practice Address - State:IA
Practice Address - Zip Code:50123-7736
Practice Address - Country:US
Practice Address - Phone:641-877-8502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherTAX ID NUMBER
IA168520Medicare Oscar/Certification