Healthcare Provider Details

I. General information

NPI: 1588636351
Provider Name (Legal Business Name): LUCAS COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 7TH ST
CHARITON IA
50049-1210
US

IV. Provider business mailing address

1200 N 7TH ST
CHARITON IA
50049-1210
US

V. Phone/Fax

Practice location:
  • Phone: 641-774-3000
  • Fax:
Mailing address:
  • Phone: 641-774-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number590108H
License Number StateIA

VIII. Authorized Official

Name: LORI JOHNSON
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 641-774-3360