Provider Demographics
NPI:1902886039
Name:ST. ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Entity Type:Organization
Organization Name:ST. ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-794-5025
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0628
Mailing Address - Country:US
Mailing Address - Phone:712-792-3581
Mailing Address - Fax:712-792-2124
Practice Address - Street 1:311 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3038
Practice Address - Country:US
Practice Address - Phone:712-792-3581
Practice Address - Fax:712-792-2124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST ANTHONY REGIONAL HOSPITAL AND NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-17
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA140090H275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0655415Medicaid
16U005OtherMEDICARE OSCAR
IA16U005Medicare Oscar/Certification