Healthcare Provider Details

I. General information

NPI: 1760432637
Provider Name (Legal Business Name): HUMBOLDT COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 15TH ST N
HUMBOLDT IA
50548-1008
US

IV. Provider business mailing address

1000 15TH ST N
HUMBOLDT IA
50548-1008
US

V. Phone/Fax

Practice location:
  • Phone: 515-332-7605
  • Fax: 515-332-7607
Mailing address:
  • Phone: 515-332-7605
  • Fax: 515-332-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number433
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier2029424
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: MICHELLE SLEITER
Title or Position: CEO
Credential:
Phone: 515-332-4200