Provider Demographics
NPI:1922087915
Name:KNOXVILLE COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:KNOXVILLE COMMUNITY HOSPITAL INC
Other - Org Name:KNOXVILLE HOSPITAL & CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-842-1400
Mailing Address - Street 1:1002 SOUTH LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-3155
Mailing Address - Country:US
Mailing Address - Phone:641-842-2151
Mailing Address - Fax:641-842-1470
Practice Address - Street 1:1002 SOUTH LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3155
Practice Address - Country:US
Practice Address - Phone:641-842-2151
Practice Address - Fax:641-842-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA630031H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0601146Medicaid
IA60114OtherWELLMARK BLUE CROSS IA
IA161355Medicare Oscar/Certification