=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841617578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF CHICKASAW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2014
-----------------------------------------------------
Last Update Date | 03/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 E PROSPECT ST
-----------------------------------------------------
City | NEW HAMPTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50659-1429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-394-4053
-----------------------------------------------------
Fax | 641-394-5814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 E PROSPECT ST PO BOX 355
-----------------------------------------------------
City | NEW HAMPTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50659-1429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-394-4053
-----------------------------------------------------
Fax | 641-394-5814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | KATHYRN BABCOCK
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 641-394-4053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | 0670760
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | 67076
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | 167076
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------