Healthcare Provider Details

I. General information

NPI: 1952466419
Provider Name (Legal Business Name): SHENANDOAH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PERSHING AVE
SHENANDOAH IA
51601-2355
US

IV. Provider business mailing address

300 PERSHING AVE
SHENANDOAH IA
51601-2355
US

V. Phone/Fax

Practice location:
  • Phone: 712-246-1230
  • Fax: 712-246-7357
Mailing address:
  • Phone: 712-246-1230
  • Fax: 712-246-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number27220
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number730065H
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number730065H
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number730065H
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number730065H
License Number StateIA

VIII. Authorized Official

Name: KAREN COLE
Title or Position: CEO
Credential:
Phone: 712-246-1230