Provider Demographics
NPI:1669893988
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:ROBERT
Authorized Official - Last Name:SLESSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-387-3145
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:563-382-2911
Mailing Address - Fax:563-387-3102
Practice Address - Street 1:112 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IA
Practice Address - Zip Code:52101
Practice Address - Country:US
Practice Address - Phone:563-532-9500
Practice Address - Fax:563-532-9599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINNESHIEK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA960127H261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0214491Medicaid
IA2214491Medicaid
IA1214491Medicaid