Provider Demographics
NPI:1174568794
Name:OTTUMWA REGIONAL HEALTH CENTER INC
Entity type:Organization
Organization Name:OTTUMWA REGIONAL HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-684-2300
Mailing Address - Street 1:1001 PENNSYLVANIA AVE
Mailing Address - Street 2:CENTRAL CLINIC BILLING
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6427
Mailing Address - Country:US
Mailing Address - Phone:641-684-3053
Mailing Address - Fax:641-683-2855
Practice Address - Street 1:1001 PENNSYLVANIA AVE
Practice Address - Street 2:CENTRAL CLINIC BILLING
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6427
Practice Address - Country:US
Practice Address - Phone:641-684-3053
Practice Address - Fax:641-683-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0286971Medicaid
IACJ4853OtherRAILROAD MEDICARE
IA42020OtherBCBS ELDON
IA0218792Medicaid
IA34032OtherBCBS MULTI SPECIALTY
IA36762OtherBCBS ALLERGY
IA268599Medicaid
IA43597OtherBCBS EDDYVILLE
IA0182600Medicaid
IA48691OtherBCBS BHCS
IAC62117OtherRAILROAD MEDICRE
IA0268599Medicaid
IA46362OtherBCBS PSYCH MED
IAI3419Medicare PIN
IACJ4853OtherRAILROAD MEDICARE
IA48691OtherBCBS BHCS
IA36762OtherBCBS ALLERGY
IA0218792Medicaid
IA43597OtherBCBS EDDYVILLE
IA34032OtherBCBS MULTI SPECIALTY