Healthcare Provider Details

I. General information

NPI: 1578588331
Provider Name (Legal Business Name): IOWA SPECIALTY HOSPITAL- CLARION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 S MAIN ST
CLARION IA
50525-2019
US

IV. Provider business mailing address

1316 S MAIN ST
CLARION IA
50525-2019
US

V. Phone/Fax

Practice location:
  • Phone: 515-532-2811
  • Fax: 515-532-9336
Mailing address:
  • Phone: 515-532-2811
  • Fax: 515-532-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number990177H
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0293522
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: STEVE SIMONIN
Title or Position: CEO
Credential:
Phone: 515-532-9333