Provider Demographics
NPI:1700941648
Name:SHENANDOAH MEDICAL CENTER
Entity type:Organization
Organization Name:SHENANDOAH MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-246-1230
Mailing Address - Street 1:802 ILLINOIS STREET
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:IA
Mailing Address - Zip Code:51652-0217
Mailing Address - Country:US
Mailing Address - Phone:712-374-6005
Mailing Address - Fax:712-374-3100
Practice Address - Street 1:802 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:IA
Practice Address - Zip Code:51652-0217
Practice Address - Country:US
Practice Address - Phone:712-374-6005
Practice Address - Fax:712-374-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA730065H261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12503Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER