Healthcare Provider Details

I. General information

NPI: 1548327364
Provider Name (Legal Business Name): STORY COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/18/2017
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: 515-382-7745
  • Fax: 515-382-7769
Mailing address:
  • Phone: 515-382-7745
  • Fax: 515-382-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number918
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number947
License Number StateIA

VIII. Authorized Official

Name: PAUL GROTELUSCHEN
Title or Position: PHARMACIST
Credential:
Phone: 515-382-7745