Healthcare Provider Details

I. General information

NPI: 1366477705
Provider Name (Legal Business Name): OTTUMWA REGIONAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PENNSYLVANIA AVE
OTTUMWA IA
52501-6427
US

IV. Provider business mailing address

1001 PENNSYLVANIA AVE
OTTUMWA IA
52501-6427
US

V. Phone/Fax

Practice location:
  • Phone: 641-682-7511
  • Fax: 641-684-2363
Mailing address:
  • Phone: 641-682-7511
  • Fax: 641-684-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateIA

VIII. Authorized Official

Name: CHAD M WOLBERS
Title or Position: INTERIM CEO
Credential:
Phone: 641-684-2300