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General NPI Number Information
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NPI Number | 1053369405
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Entity Type | Organization
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Legal Business Name | PELLA REGIONAL HEALTH CENTER
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 405 MONROE ST
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City | PELLA
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State | IA
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Zip | 50219-1189
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Country | US
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Telephone | 641-628-3832
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Fax | 641-628-8894
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Provider Business Mailing Address
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Address Line | 405 MONROE ST
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City | PELLA
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State | IA
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Zip | 50219-1189
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Country | US
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Telephone | 641-628-3832
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Fax | 641-628-8894
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Authorized Official
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Title or Position | CEO
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Name | ROBERT D KROESE
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Credential |
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Telephone | 641-628-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 630165H
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 630165H
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 630165H
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License Number State | IA
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