Healthcare Provider Details

I. General information

NPI: 1891659504
Provider Name (Legal Business Name): KALONA COOPERATIVE TECHNOLOGY COMPNAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 B AVE
KALONA IA
52247-7720
US

IV. Provider business mailing address

PO BOX 1208
KALONA IA
52247-1208
US

V. Phone/Fax

Practice location:
  • Phone: 319-656-3668
  • Fax: 319-656-4484
Mailing address:
  • Phone: 319-656-3668
  • Fax: 319-656-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MARY MILLER
Title or Position: BILLING MANAGER
Credential:
Phone: 319-656-3668