Provider Demographics
NPI:1023084548
Name:CLARKE COUNTY
Entity type:Organization
Organization Name:CLARKE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-342-3724
Mailing Address - Street 1:134 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1286
Mailing Address - Country:US
Mailing Address - Phone:641-342-3724
Mailing Address - Fax:641-342-2603
Practice Address - Street 1:134 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1286
Practice Address - Country:US
Practice Address - Phone:641-342-3724
Practice Address - Fax:641-342-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAF246189OtherMIDLANDS CHOICE
IA67125OtherBLUE SHIELD
IA0671255Medicaid
IA0671255Medicaid