Provider Demographics
NPI:1255355848
Name:MOUNT AYR CSD
Entity type:Organization
Organization Name:MOUNT AYR CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-464-0512
Mailing Address - Street 1:1001 E COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854-2220
Mailing Address - Country:US
Mailing Address - Phone:641-464-0533
Mailing Address - Fax:641-464-2325
Practice Address - Street 1:1001 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-2220
Practice Address - Country:US
Practice Address - Phone:641-464-0533
Practice Address - Fax:641-464-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0286963Medicaid