Healthcare Provider Details

I. General information

NPI: 1962757781
Provider Name (Legal Business Name): STOLZ MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E ERIE ST
MISSOURI VALLEY IA
51555-1673
US

IV. Provider business mailing address

515 E ERIE ST
MISSOURI VALLEY IA
51555-1673
US

V. Phone/Fax

Practice location:
  • Phone: 712-642-2264
  • Fax:
Mailing address:
  • Phone: 712-642-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number44-55
License Number StateIA

VIII. Authorized Official

Name: COLLEEN M STOLZ
Title or Position: PRESIDENT
Credential:
Phone: 402-995-0340