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General NPI Number Information
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NPI Number | 1245857515
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Entity Type | Organization
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Legal Business Name | WINNESHIEK MEDICAL CENTER
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 605 WASHINGTON ST
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City | FAYETTE
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State | IA
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Zip | 52142-9206
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Country | US
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Telephone | 563-382-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 901 MONTGOMERY ST
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City | DECORAH
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State | IA
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Zip | 52101-2325
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Country | US
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Telephone | 563-382-2911
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Fax |
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Authorized Official
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Title or Position | CAO
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Name | STEVEN ROBERT SLESSOR
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Credential |
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Telephone | 563-387-3145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 2908209
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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Identifier #2
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Identifier Code | 3908209
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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Identifier #3
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Identifier Code | 0908209
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0908209
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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Identifier #2
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Identifier Code | 2908209
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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Identifier #3
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Identifier Code | 3908209
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Identifier Type | MEDICAID
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Identifier State | IA
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Identifier Issuer |
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