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4022 Main Street Elk Horn IA 51531-2102 | |
(712) 764-4642 | |
(712) 764-4643 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4022 Main Street, Elk Horn, Iowa |
Authorized Official Name and Position | Barry A. Jacobsen (CEO) |
Authorized Official Contact | 7127554315 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1213 Garfield Ave Harlan IA 51537-2057 Ph: (712) 755-5161 | 4022 Main Street Elk Horn IA 51531-2102 Ph: (712) 764-4642 |
NPI Number | 1467569905 |
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Provider Enumeration Date | 08/23/2006 |
Last Update Date | 12/14/2010 |
Medicare PECOS PAC ID | 5193619393 |
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Medicare Enrollment ID | O20051004000883 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467569905 | NPI | - | NPPES |
0685149 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |