Story County Hospital

Organization Active NPI Family Medicine Physician · Nevada, IA

NPI 1023080504 · NPPES record last updated Feb 10, 2017

Key facts

NPI
1023080504
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
STORY COUNTY HOSPITAL
Practice address
640 S 19TH St
Nevada, IA 50201-2902
Phone
(515) 382-5413
Fax
(515) 382-7107
NPI assigned
Feb 7, 2006
Organization subpart
No

Authorized official

Name
Mrs. Kemberlee S Packer
Title
Credentialing Specialist
Phone
(515) 382-7101

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040204000957 IA Part B Supplier - Clinic/Group Practice 0547153884 Receives reassigned benefits from 39 practitioners
5 other NPIs on this enrollment
Practice locations: Nevada, IA

National Provider Directory

Locations

600 Linn St
Ste B
Slater, IA 50244
Phone (515) 685-3960

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP
207Q00000X Yes

Addresses

Primary practice location

640 S 19TH St
Nevada, IA 50201-2902

Mailing address

640 S 19TH St
Nevada, IA 50201-2902
Phone (515) 382-5413

Other identifiers

IdentifierTypeStateIssuer
48680OtherIAWELLMARK BCBS
0251553MedicaidIA

Other names

  • Nevada Medical Clinic Doing business as

Other providers in Nevada, IA

All providers in Nevada, IA · Family Medicine Physician in Iowa

Sources for this page

Verify at the official NPI Registry.