Provider Demographics
NPI:1144853516
Name:ELLSWORTH MUNICIPAL HOSPITAL
Entity type:Organization
Organization Name:ELLSWORTH MUNICIPAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VON MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-648-7010
Mailing Address - Street 1:112 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ZEARING
Mailing Address - State:IA
Mailing Address - Zip Code:50278-7728
Mailing Address - Country:US
Mailing Address - Phone:641-487-7800
Mailing Address - Fax:641-487-7800
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ZEARING
Practice Address - State:IA
Practice Address - Zip Code:50278-7728
Practice Address - Country:US
Practice Address - Phone:641-487-7800
Practice Address - Fax:641-487-7803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTH MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-13
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health