Healthcare Provider Details

I. General information

NPI: 1023080504
Provider Name (Legal Business Name): STORY COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S 19TH ST
NEVADA IA
50201-2902
US

IV. Provider business mailing address

640 S 19TH ST
NEVADA IA
50201-2902
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-5413
  • Fax: 515-382-7107
Mailing address:
  • Phone: 515-382-5413
  • Fax: 515-382-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KEMBERLEE S PACKER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 515-382-7101