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802 Illinois St Sidney IA 51652-8028 | |
(712) 374-6005 | |
(712) 374-3100 |
Full Name | |
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Speciality | Clinic/Center |
Location | 802 Illinois St, Sidney, Iowa |
Authorized Official Name and Position | Karen S Cole (CEO) |
Authorized Official Contact | 7122461230 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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300 Pershing Ave Shenandoah IA 51601-2355 Ph: (712) 246-1230 | 802 Illinois St Sidney IA 51652-8028 Ph: (712) 374-6005 |
NPI Number | 1497150825 |
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Provider Enumeration Date | 10/28/2014 |
Last Update Date | 10/28/2014 |
Medicare PECOS PAC ID | 9436063237 |
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Medicare Enrollment ID | O20141205001157 |
Identifier | Type | State | Issuer |
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1497150825 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 730065H (Iowa) | Primary |