Healthcare Provider Details

I. General information

NPI: 1790893469
Provider Name (Legal Business Name): POCAHONTAS COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 NW 7TH ST
POCAHONTAS IA
50574-1028
US

IV. Provider business mailing address

606 NW 7TH ST
POCAHONTAS IA
50574-1028
US

V. Phone/Fax

Practice location:
  • Phone: 712-335-3501
  • Fax: 712-335-4116
Mailing address:
  • Phone: 712-335-3501
  • Fax: 712-335-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number760133H
License Number StateIA

VIII. Authorized Official

Name: MR. JAMES ROETMAN
Title or Position: CEO
Credential:
Phone: 712-335-3501