Healthcare Provider Details

I. General information

NPI: 1043229735
Provider Name (Legal Business Name): ELLSWORTH MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SOUTH OAK ST SUITE 1
IOWA FALLS IA
50126-9506
US

IV. Provider business mailing address

920 SOUTH OAK ST SUITE 1
IOWA FALLS IA
50126-9506
US

V. Phone/Fax

Practice location:
  • Phone: 641-648-7100
  • Fax: 641-648-7095
Mailing address:
  • Phone: 641-648-7101
  • Fax: 641-648-7095

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 Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GEORGE VON MOCK
Title or Position: CEO
Credential:
Phone: 641-648-7010