Provider Demographics
NPI:1356359061
Name:ELLSWORTH MUNICIPAL HOSPITAL
Entity type:Organization
Organization Name:ELLSWORTH MUNICIPAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VON MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-648-7010
Mailing Address - Street 1:1000 10TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ACKLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50601-1456
Mailing Address - Country:US
Mailing Address - Phone:641-847-2625
Mailing Address - Fax:641-847-2509
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:ACKLEY
Practice Address - State:IA
Practice Address - Zip Code:50601-1701
Practice Address - Country:US
Practice Address - Phone:641-847-2625
Practice Address - Fax:641-847-2509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTH MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12852OtherMEDICARE-PTAN
IA0442764Medicaid