Provider Demographics
NPI:1104507060
Name:WINNESHIEK MEDICAL CENTER
Entity type:Organization
Organization Name:WINNESHIEK MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLESSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-387-3000
Mailing Address - Street 1:901 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2325
Mailing Address - Country:US
Mailing Address - Phone:563-387-3000
Mailing Address - Fax:563-387-3140
Practice Address - Street 1:901 MONTGOMERY ST STE A
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2325
Practice Address - Country:US
Practice Address - Phone:563-387-3000
Practice Address - Fax:563-387-3140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINNESHIEK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0514362Medicaid