Healthcare Provider Details

I. General information

NPI: 1700941648
Provider Name (Legal Business Name): SHENANDOAH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 ILLINOIS ST
SIDNEY IA
51652-0217
US

IV. Provider business mailing address

802 ILLINOIS STREET
SIDNEY IA
51652-0217
US

V. Phone/Fax

Practice location:
  • Phone: 712-374-6005
  • Fax: 712-374-2301
Mailing address:
  • Phone: 712-374-6005
  • Fax: 712-374-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number730065H
License Number StateIA

VIII. Authorized Official

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