=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053305326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHINGTON COUNTY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2005
-----------------------------------------------------
Last Update Date | 01/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 E POLK ST
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52353-1237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-653-5481
-----------------------------------------------------
Fax | 319-653-4271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 E POLK ST PO BOX 909
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52353-1237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-653-5481
-----------------------------------------------------
Fax | 319-863-3963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TODD PATTERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 319-863-3901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 920052H
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------