Healthcare Provider Details

I. General information

NPI: 1215962550
Provider Name (Legal Business Name): NORTHWEST IOWA HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

IV. Provider business mailing address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

V. Phone/Fax

Practice location:
  • Phone: 712-279-3789
  • Fax:
Mailing address:
  • Phone: 712-279-3500
  • Fax: 712-279-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number180H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number180H
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number180H
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number180H
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES L GOBELL
Title or Position: VP/CFO
Credential:
Phone: 712-279-3934