Provider Demographics
NPI:1720067127
Name:ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Entity Type:Organization
Organization Name:ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-794-5025
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0628
Mailing Address - Country:US
Mailing Address - Phone:712-792-3581
Mailing Address - Fax:712-792-2124
Practice Address - Street 1:311 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3038
Practice Address - Country:US
Practice Address - Phone:712-792-3581
Practice Address - Fax:712-792-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
IA140090H282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600056Medicaid
IA0600056Medicaid
IA160005Medicare Oscar/Certification