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General NPI Number Information
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NPI Number | 1659353670
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Entity Type | Organization
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Legal Business Name | SOUTHERN IOWA MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 1527 ALBIA RD
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City | OTTUMWA
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State | IA
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Zip | 52501-3907
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Country | US
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Telephone | 641-682-8772
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Fax | 641-682-1924
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Provider Business Mailing Address
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Address Line | 1527 ALBIA RD
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City | OTTUMWA
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State | IA
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Zip | 52501-3907
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Country | US
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Telephone | 641-682-8772
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Fax | 641-682-1924
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CHRISTINA SCHARK
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Credential | MHA
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Telephone | 641-682-8772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 1653953670
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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 | 1659353670
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | BLUE CROSS & BLUE SHIELD OF IA
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 1653953670
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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 | 1659353670
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | BLUE CROSS & BLUE SHIELD OF IA
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