Healthcare Provider Details

I. General information

NPI: 1053738765
Provider Name (Legal Business Name): ELLSWORTH MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S OAK ST
IOWA FALLS IA
50126-9506
US

IV. Provider business mailing address

1000 10TH AVE
ACKLEY IA
50601-1701
US

V. Phone/Fax

Practice location:
  • Phone: 641-648-7044
  • Fax: 641-648-7019
Mailing address:
  • Phone: 641-847-2625
  • Fax: 641-847-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberB135725
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number420156H
License Number StateIA

VIII. Authorized Official

Name: MR. MICHAEL WHITE
Title or Position: CEO
Credential:
Phone: 641-648-4631