Provider Demographics
NPI:1922116607
Name:POCAHONTAS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:POCAHONTAS COMMUNITY HOSPITAL
Other - Org Name:POCAHONTAS COMMUNITY HOSPITAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-335-3501
Mailing Address - Street 1:606 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1099
Mailing Address - Country:US
Mailing Address - Phone:712-335-3501
Mailing Address - Fax:712-335-4116
Practice Address - Street 1:606 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1099
Practice Address - Country:US
Practice Address - Phone:712-335-3430
Practice Address - Fax:712-335-4116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POCAHONTAS COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA61522OtherBLUE CROSS HOSPICE
IA0615229Medicaid
IA161522Medicare Oscar/Certification