Healthcare Provider Details

I. General information

NPI: 1275995045
Provider Name (Legal Business Name): JASPER COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 2ND AVENUE E COUNTY ANNEX BUILDING B-1
NEWTON IA
50208
US

IV. Provider business mailing address

115 N 2ND AVENUE E COUNTY ANNEX BUILDING B-1
NEWTON IA
50208
US

V. Phone/Fax

Practice location:
  • Phone: 641-787-9224
  • Fax: 641-792-5700
Mailing address:
  • Phone: 641-787-9224
  • Fax: 641-792-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0211672
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: REBECCA PRYOR
Title or Position: ADMINSTRATOR
Credential: RN
Phone: 641-787-9224