MEDICARE: FORT MADISON HEALTH CENTER OPERATIONS LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1821620097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT MADISON HEALTH CENTER OPERATIONS LLC

Provider Business Mailing Address
First Line	:	4611 TIMBERLAND CT NE
Second Line	:
City	:	SOLON
State	:	IA
Zip	:	52333-4703
Country	:	US
Telephone Number	:	319-644-3479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 41ST ST
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-3269
Country	:	US
Telephone Number	:	319-372-8021
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. MARK HOLTKAMP
Credential	:
Telephone Number	:	319-644-3479

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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