Provider Demographics
NPI:1922077064
Name:MAHASKA COUNTY HOSPITAL
Entity Type:Organization
Organization Name:MAHASKA COUNTY HOSPITAL
Other - Org Name:MAHASKA HEALTH PARTNERSHIP COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DERONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-672-3392
Mailing Address - Street 1:1229 C AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4298
Mailing Address - Country:US
Mailing Address - Phone:641-672-3100
Mailing Address - Fax:641-672-3336
Practice Address - Street 1:1229 C AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4298
Practice Address - Country:US
Practice Address - Phone:641-672-3100
Practice Address - Fax:641-672-3336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHASKA COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670406Medicaid
IA67040OtherWELLMARK PROVIDER NUMBER
IA67040OtherWELLMARK PROVIDER NUMBER