Healthcare Provider Details

I. General information

NPI: 1962635615
Provider Name (Legal Business Name): IDA COUNTY IOWA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E 2ND ST SUITE 2
IDA GROVE IA
51445-1601
US

IV. Provider business mailing address

701 EAST 2ND STREET
IDA GROVE IA
51445-1699
US

V. Phone/Fax

Practice location:
  • Phone: 712-364-2514
  • Fax:
Mailing address:
  • Phone: 712-364-3311
  • Fax: 712-364-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JONI G. SCHUMANN
Title or Position: CFO
Credential:
Phone: 712-364-7225