MEDICARE: COUNTY OF EMMET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	67084	OTHER	IA	WELLMARK

General Provider Information

NPI Number	:	1669456398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF EMMET

Provider Business Mailing Address
First Line	:	508 SOUTH 1ST ST.
Second Line	:
City	:	ESTHERVILLE
State	:	IA
Zip	:	51334-2429
Country	:	US
Telephone Number	:	712-362-2490
Fax Number	:	712-362-7160

Provider Business Practice Location Address
First Line	:	508 SOUTH 1ST ST.
Second Line	:
City	:	ESTHERVILLE
State	:	IA
Zip	:	51334-2429
Country	:	US
Telephone Number	:	712-362-2490
Fax Number	:	712-362-7160

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY MOORMAN IV
Credential	:
Telephone Number	:	712-362-2490

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	02/11/2014

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Directions to “COUNTY OF EMMET ” Practice Location

Language	Start Address	Practice Location

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