Healthcare Provider Details

I. General information

NPI: 1790840239
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: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PARK AVENUE
SHENANDOAH IA
51601-2355
US

IV. Provider business mailing address

300 PERSHING AVE
SHENANDOAH IA
51601-2355
US

V. Phone/Fax

Practice location:
  • Phone: 712-246-7317
  • Fax: 712-246-7311
Mailing address:
  • Phone: 712-246-1230
  • Fax: 712-246-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number730065H
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0672790
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

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