Healthcare Provider Details

I. General information

NPI: 1508839325
Provider Name (Legal Business Name): M & D HAMM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BLAKE ST
SIOUX RAPIDS IA
50585-1121
US

IV. Provider business mailing address

1912 ZENITH AVE SUITE 2526
SPIRIT LAKE IA
51360-1000
US

V. Phone/Fax

Practice location:
  • Phone: 712-283-2302
  • Fax: 712-283-2487
Mailing address:
  • Phone: 712-759-1321
  • Fax: 712-759-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number110599
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number110599
License Number StateIA

VIII. Authorized Official

Name: DOUGLAS D JOHNSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 515-223-0173