MEDICARE: PELLA REGIONAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1245712942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELLA REGIONAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	404 EAST 2ND STREET
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228-0430
Country	:	US
Telephone Number	:	515-994-2617
Fax Number	:	515-994-2365

Provider Business Practice Location Address
First Line	:	404 EAST 2ND STREET
Second Line	:
City	:	PRAIRIE CITY
State	:	IA
Zip	:	50228-0430
Country	:	US
Telephone Number	:	515-994-2617
Fax Number	:	515-994-2365

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT D. KROESE
Credential	:
Telephone Number	:	641-628-6604

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	11/09/2021

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Directions to “PELLA REGIONAL HEALTH CENTER ” Practice Location

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