=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992708531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALO ALTO COUNTY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 12/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 1ST ST
-----------------------------------------------------
City | EMMETSBURG
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50536-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-852-5419
-----------------------------------------------------
Fax | 712-852-5513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 1ST ST
-----------------------------------------------------
City | EMMETSBURG
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50536-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-852-5500
-----------------------------------------------------
Fax | 712-852-5477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CEO
-----------------------------------------------------
Name | MR. THOMAS J LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-852-5401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 167049
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------