Provider Demographics
NPI:1982006359
Name:IDA COUNTY IOWA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:IDA COUNTY IOWA COMMUNITY HOSPITAL
Other - Org Name:HORN PHYSICIANS CLINIC ODEBOLT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-364-7225
Mailing Address - Street 1:701 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-1666
Mailing Address - Country:US
Mailing Address - Phone:712-364-3311
Mailing Address - Fax:
Practice Address - Street 1:300 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ODEBOLT
Practice Address - State:IA
Practice Address - Zip Code:51458-7714
Practice Address - Country:US
Practice Address - Phone:712-668-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IDA COUNTY IOWA COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-17
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA470061H261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1500OtherMEDICARE PTAN