Healthcare Provider Details

I. General information

NPI: 1073939088
Provider Name (Legal Business Name): CLARKE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MAIN ST.
OSCEOLA IA
50213
US

IV. Provider business mailing address

109 S MAIN ST.
OSCEOLA IA
50213
US

V. Phone/Fax

Practice location:
  • Phone: 641-342-3724
  • Fax: 641-342-2603
Mailing address:
  • Phone: 641-342-3724
  • Fax: 641-342-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JIMMERSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 641-342-3724