| Southern Iowa Mental Health Center | |
|
1527 Albia Rd Ottumwa IA 52501-3907 | |
| (641) 682-8772 | |
| (641) 682-1924 |
| Full Name | Southern Iowa Mental Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1527 Albia Rd, Ottumwa, Iowa |
| Authorized Official Name and Position | Christina Schark (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6416828772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Iowa Mental Health Center 1527 Albia Rd Ottumwa IA 52501-3907 Ph: (641) 682-8772 | Southern Iowa Mental Health Center 1527 Albia Rd Ottumwa IA 52501-3907 Ph: (641) 682-8772 |
| NPI Number | 1659353670 |
|---|---|
| Provider Enumeration Date | 11/16/2005 |
| Last Update Date | 12/10/2021 |
| Certification Date | 09/10/2020 |
| Medicare PECOS PAC ID | 6002809647 |
|---|---|
| Medicare Enrollment ID | O20040407001335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659353670 | NPI | - | NPPES |
| 1653953670 | Medicaid | IA | |
| 1659353670 | Other | BLUE CROSS & BLUE SHIELD OF IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Darissa D Chance |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265425805 PECOS PAC ID: 8628981230 Enrollment ID: I20031110000630 |
| Provider Name | Jimmy R Mascaro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104998251 PECOS PAC ID: 0042210973 Enrollment ID: I20061228000077 |
| Provider Name | Hilda M Mascaro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427215110 PECOS PAC ID: 4284886003 Enrollment ID: I20130115000251 |
| Provider Name | April K Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225339088 PECOS PAC ID: 8921234238 Enrollment ID: I20131114001764 |
| Provider Name | Rhonda J Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154793446 PECOS PAC ID: 7517226350 Enrollment ID: I20180124000505 |
| Provider Name | Shoshannah N Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871944009 PECOS PAC ID: 1850643362 Enrollment ID: I20181011000909 |
| Provider Name | Jennifer R Stromgren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013525054 PECOS PAC ID: 0941614358 Enrollment ID: I20210126002660 |
| Provider Name | Mendy M Shepard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205588191 PECOS PAC ID: 5496148421 Enrollment ID: I20220215001170 |
| Provider Name | Sydney A Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326665373 PECOS PAC ID: 1254717549 Enrollment ID: I20221011001015 |
| Provider Name | Kirby Rowl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679130967 PECOS PAC ID: 4880052513 Enrollment ID: I20230628000135 |
| Provider Name | Rebecca A Cole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376942136 PECOS PAC ID: 7315246659 Enrollment ID: I20231026002818 |
| Provider Name | Allison D Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700353083 PECOS PAC ID: 3577911379 Enrollment ID: I20231204002119 |
| Provider Name | Jacoby Deshler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518618453 PECOS PAC ID: 5799122149 Enrollment ID: I20240321002006 |
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