Provider Demographics
NPI:1811976194
Name:ANAMOSA COMMUNITY HOSPITAL, INC.
Entity type:Organization
Organization Name:ANAMOSA COMMUNITY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-462-6131
Mailing Address - Street 1:104 BROADWAY PL
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1100
Mailing Address - Country:US
Mailing Address - Phone:319-462-6131
Mailing Address - Fax:319-462-4689
Practice Address - Street 1:104 BROADWAY PL
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1100
Practice Address - Country:US
Practice Address - Phone:319-462-6131
Practice Address - Fax:319-462-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAADS114251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0671370Medicaid